Provider Demographics
NPI:1386036648
Name:BARDEN, LEAH MYHANH (MSEDUCATION)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MYHANH
Last Name:BARDEN
Suffix:
Gender:F
Credentials:MSEDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31946 MISSION TRL
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4539
Mailing Address - Country:US
Mailing Address - Phone:951-245-7663
Mailing Address - Fax:951-674-6431
Practice Address - Street 1:31946 MISSION TRL
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4539
Practice Address - Country:US
Practice Address - Phone:951-245-7663
Practice Address - Fax:951-674-6431
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
CA172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist