Provider Demographics
NPI:1821626938
Name:LEACH, GARRISON ALECSANDER (MD)
Entity Type:Individual
Prefix:
First Name:GARRISON
Middle Name:ALECSANDER
Last Name:LEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR # MC8890
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1911
Mailing Address - Country:US
Mailing Address - Phone:619-543-6084
Mailing Address - Fax:619-543-3645
Practice Address - Street 1:200 W ARBOR DR # MC8890
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1911
Practice Address - Country:US
Practice Address - Phone:619-543-6084
Practice Address - Fax:619-543-3645
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program