Provider Demographics
NPI:1811495948
Name:LEAHY, DIEP HOANG (NP-BC)
Entity type:Individual
Prefix:
First Name:DIEP
Middle Name:HOANG
Last Name:LEAHY
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 QUEENS WAY
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5330
Mailing Address - Country:US
Mailing Address - Phone:818-709-4496
Mailing Address - Fax:
Practice Address - Street 1:2791 AGOURA RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-3101
Practice Address - Country:US
Practice Address - Phone:805-495-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty