Provider Demographics
NPI:1619584349
Name:MAGO, LEIGHAH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:LEIGHAH
Middle Name:
Last Name:MAGO
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 EASY ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4130
Mailing Address - Country:US
Mailing Address - Phone:408-712-8901
Mailing Address - Fax:
Practice Address - Street 1:1726 CHADWICK CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3318
Practice Address - Country:US
Practice Address - Phone:817-510-6662
Practice Address - Fax:817-280-9962
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99397176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife