Provider Demographics
NPI:1942764097
Name:GIRIUNAS, LEIGHANN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:
Last Name:GIRIUNAS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HAWTHORNE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3114
Mailing Address - Country:US
Mailing Address - Phone:510-452-1345
Mailing Address - Fax:510-463-0280
Practice Address - Street 1:365 HAWTHORNE AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3114
Practice Address - Country:US
Practice Address - Phone:510-452-1345
Practice Address - Fax:510-452-1102
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant