Individual
JENNIFER LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25292 MCINTYRE ST, LAGUNA HILLS, CA 92653-5434
(949) 560-4569
Mailing address
33501 SEA BRIGHT DR, DANA POINT, CA 92629-3159
(949) 560-4569
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
U6061664
CA
Other
Enumeration date
09/17/2024
Last updated
09/17/2024
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