Provider Demographics
NPI:1215116744
Name:REDWOOD, LEAH MCLEAN (LM)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MCLEAN
Last Name:REDWOOD
Suffix:
Gender:F
Credentials:LM
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:KATHRYN
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM
Mailing Address - Street 1:2817 CALIFORNIA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2011
Mailing Address - Country:US
Mailing Address - Phone:415-250-3653
Mailing Address - Fax:
Practice Address - Street 1:2817 CALIFORNIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2011
Practice Address - Country:US
Practice Address - Phone:510-704-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM140176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALM140OtherSTATE OF CALIFORNIA MEDICAL BOARD