MR. LEON KOENCK (NPI# 1164555769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164555769 |
| Entity Type | Individual |
| Full Name | MR. LEON KOENCK |
| Credential | PA C |
| Practice Address |
46900 Ocean Dr Ste 1100 Gualala CA 95445-8353 |
| Mailing Address |
200 West 34th Avenue #539 Anchorage AK 99503 |
| Practice Telephone | 7078844005 |
| Practice Fax Number | 7078844625 |
| Mailing Telephone | 8883000137 |
| Mailing Fax Number | 8883000137 |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2016-02-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA 10003212 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363A00000X | Physician Assistant | PA19714 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 270 | AK | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA10003212 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA19714 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
46900 OCEAN DR STE 1100 |
| City | GUALALA |
| State | CA |
| Zip Code | 95445-8353 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649279233 | Northern California Medical Assoc Inc | Internal Medicine | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2005-07-18 |
| 1558707968 | Adele Zita | Registered Nurse | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2013-05-13 |
| 1407030968 | Jefferson Nerney | Psychologist | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2007-12-19 |
| 1093833659 | Jere Alm | Physician Assistant | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2007-03-26 |
| 1962530725 | Redwood Coast Medical Services, Inc. | Clinic/Center | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2007-03-01 |
| 1952494817 | Joanne C. Brooks | Family Medicine | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2006-10-02 |
| 1346332335 | Lois Falk | Nurse Practitioner | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2006-09-28 |
| 1780776682 | Roberta U. Rams | Dentist | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2006-09-28 |
| 1851379705 | Elizabeth J Nagle | Nurse Practitioner | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2006-01-01 |
| 1316937931 | Mark Kal | Family Medicine | 46900 Ocean Dr, Gualala, CA 95445-8353 | 2005-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205453586 | Mendocino Pharmacy Holdings Inc. | Pharmacy | 39251 South Highway 1, Gualala, CA 95445 | 2020-07-02 |
| 1922659499 | Lucinda Weaver Physical Therapy | Clinic/Center | 39120 Ocean Dr, Gualala, CA 95445 | 2019-09-25 |
| 1275858573 | James Edwin Platt | Chiropractor | 38820 Hwy. 1, Suite 108, Gualala, CA 95445 | 2010-03-30 |
| 1184862013 | Lucinda Weaver I | Physical Therapist | 39120 Ocean Dr., Gualala, CA 95445 | 2009-01-30 |
| 1902050669 | Gena Lynn Davis | Optometrist | 39150 Ocean Drive, Suite 2a, Gualala, CA 95445 | 2008-11-07 |
| 1477731032 | Carolee Brady | Marriage & Family Therapist | 38550 S Hwy 1, Gualala, CA 95445 | 2008-02-06 |
| 1053432971 | Barbara Brittell | Physician Assistant | 46900 Ocean Drive, Redwood Coast Medical Services, Gualala, CA 95445 | 2007-04-02 |
| 1174658298 | Richard T Miner | Chiropractor | 38690 Pacific Dr., Suite 3, Gualala, CA 95445 | 2007-02-22 |
| 1104962638 | Robert Arnold Nelson | Ophthalmology | 30150 So Hwy One, Gualala, CA 95445 | 2007-01-30 |
| 1982808119 | Allen B. Cox Jr. | Dentist | 38460 S. Highway One, Gualala, CA 95445-1199 | 2007-06-12 |
| Find all providers in zip 95445 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407679 | Samantha Sidney Spinner | Physician Assistant | 1385 Shattuck Ave Apt 201, Berkeley, CA 94709-1468 | 2020-11-08 |
| 1134720972 | Alessandra Porfido | Physician Assistant | 733 Filbert St Apt 1, San Francisco, CA 94133-2767 | 2020-11-06 |
| 1992306872 | Kelsey Oberg | Physician Assistant | 1817 Oldfield Ct, El Cajon, CA 92019-4233 | 2020-11-05 |
| 1609477504 | Julia Claire Stiefel | Physician Assistant | 369 Orange St Apt A, Oakland, CA 94610-2979 | 2020-11-05 |
| 1164023347 | Wendy P Lewis | Physician Assistant | 10447 Highdale St, Bellflower, CA 90706-4122 | 2020-11-04 |
| 1245830181 | Lauren Bennett | Physician Assistant | 3360 Horizon St, Corona, CA 92881-0728 | 2020-10-29 |
| 1538769062 | Revital Ahl | Physician Assistant | 18141 Medley Dr, Encino, CA 91316-4447 | 2020-10-26 |
| 1922607423 | Emily Halla | Physician Assistant | 7473 Gresham Ct, San Jose, CA 95139-1424 | 2020-10-26 |
| 1386243889 | Ilaitia Lecia Namatasere | Physician Assistant | 614 Sycamore Ln Apt 225, Davis, CA 95616-7901 | 2020-10-26 |
| 1083213706 | Courtney Kathryn Hopp | Physician Assistant | 4060 Fourth Ave Ste 209, San Diego, CA 92103-2120 | 2020-10-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.