Provider Demographics
NPI:1669205464
Name:TODD, LEADA OMIDVAR
Entity type:Individual
Prefix:MRS
First Name:LEADA
Middle Name:OMIDVAR
Last Name:TODD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEADA
Other - Middle Name:OMIDVAR
Other - Last Name:GHAREAGHADJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4218 NEWTON AVE APT E
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3148
Mailing Address - Country:US
Mailing Address - Phone:909-725-4384
Mailing Address - Fax:
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2796
Practice Address - Country:US
Practice Address - Phone:682-885-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX896595163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics