Provider Demographics
NPI:1992398556
Name:LEONARDO, NICHOLAS (RD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:LEONARDO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 LEWELLING CT
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5314
Mailing Address - Country:US
Mailing Address - Phone:510-300-4018
Mailing Address - Fax:
Practice Address - Street 1:3050 S DELAWARE ST STE 130
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2394
Practice Address - Country:US
Practice Address - Phone:650-319-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered