Provider Demographics
NPI:1568429660
Name:LEACH, RICHARD JOEL (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOEL
Last Name:LEACH
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2868
Mailing Address - Country:US
Mailing Address - Phone:916-782-2229
Mailing Address - Fax:916-797-9414
Practice Address - Street 1:5 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2868
Practice Address - Country:US
Practice Address - Phone:916-782-2229
Practice Address - Fax:916-797-9414
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31695207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C316951Medicaid
CA00C316951Medicare ID - Type UnspecifiedMEDICARE#
CA00C316951Medicaid