Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 119446 | OR |
NPI | 1073283420 |
---|---|
Provider Name | Yesica Leon |
First Address | Portland, OR 97220-4456 |
Second Address | Portland, OR 97220-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2021 |
Last Update Date | 16/09/2021 |