Provider Demographics
NPI:1396257283
Name:GORDON, LEAH DANIELLE (ND)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DANIELLE
Last Name:GORDON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 HERMES AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1797
Mailing Address - Country:US
Mailing Address - Phone:970-443-5419
Mailing Address - Fax:
Practice Address - Street 1:7650 GIRARD AVE STE 401
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4447
Practice Address - Country:US
Practice Address - Phone:970-443-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND922175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath