Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1699366047 |
---|---|
Provider Name | Monica Carolina Leon |
First Address | Henderson, NV 89014-2371 |
Second Address | Las Vegas, NV 89121-3624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 01/04/2021 |