Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1043877814 |
---|---|
Provider Name | Madelaine Leon |
First Address | Cutler Bay, FL 33157-7733 |
Second Address | Cutler Bay, FL 33157-7733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 28/05/2019 |