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Individual
LEAH ANTUNES
Active
Individual
LEAH ANTUNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMA
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
100295992
SC
251S00000X
Community/Behavioral Health Agency
475267829
SC
251V00000X
Voluntary or Charitable Agency
475267829
SC
302F00000X
Exclusive Provider Organization
Primary
47-5267829
SC
347C00000X
Private Vehicle
100295992
SC
Other
Enumeration date
11/20/2015
Last updated
06/23/2016
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