Provider Demographics
NPI:1679554398
Name:LEBARON, DANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANETTE
Middle Name:
Last Name:LEBARON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 GERMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-8314
Mailing Address - Country:US
Mailing Address - Phone:707-628-2735
Mailing Address - Fax:
Practice Address - Street 1:3035 GERMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-8314
Practice Address - Country:US
Practice Address - Phone:707-628-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53286208000000X
IN01054988A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics