Provider Demographics
NPI:1912748310
Name:LEACHMAN, GRETTA
Entity type:Individual
Prefix:
First Name:GRETTA
Middle Name:
Last Name:LEACHMAN
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:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-0118
Mailing Address - Country:US
Mailing Address - Phone:858-232-0237
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 15
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92018-0118
Practice Address - Country:US
Practice Address - Phone:858-232-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No374U00000XNursing Service Related ProvidersHome Health Aide