Provider Demographics
NPI:1013678721
Name:BARGAS, LEEANNE MICHELLE
Entity Type:Individual
Prefix:
First Name:LEEANNE
Middle Name:MICHELLE
Last Name:BARGAS
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 1:6407 LINN WAY
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-3218
Mailing Address - Country:US
Mailing Address - Phone:916-578-2660
Mailing Address - Fax:
Practice Address - Street 1:6407 LINN WAY
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-3218
Practice Address - Country:US
Practice Address - Phone:916-578-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist