Provider Demographics
NPI:1760863765
Name:STURDEVANT, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11243 PASEO MONTANOSO
Mailing Address - Street 2:APT. 99
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5970
Mailing Address - Country:US
Mailing Address - Phone:858-361-1767
Mailing Address - Fax:
Practice Address - Street 1:2605 CARLSBAD BLVD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2208
Practice Address - Country:US
Practice Address - Phone:760-729-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer