Provider Demographics
NPI:1265091250
Name:SUTTON-BARNES, LEIA (LAC)
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:
Last Name:SUTTON-BARNES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E REMINGTON DR STE 25
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2612
Mailing Address - Country:US
Mailing Address - Phone:408-720-1766
Mailing Address - Fax:408-720-1763
Practice Address - Street 1:500 E REMINGTON DR STE 25
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2612
Practice Address - Country:US
Practice Address - Phone:408-720-1766
Practice Address - Fax:408-720-1763
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16805171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist