MEDICARE: VANIOLKY LOSADA LEON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	35C.003033	OH
2	2084N0400X	Neurology Physician	ME148664	FL
3	2084N0400X	Neurology Physician	W0436	TX
4	2084N0400X	Neurology Physician	78061	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043690423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANIOLKY LOSADA LEON

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-1290
Fax Number	:	239-343-4008

Provider Business Practice Location Address
First Line	:	11215 METRO PKWY STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1206
Country	:	US
Telephone Number	:	239-208-2212
Fax Number	:	239-208-3994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	04/13/2026

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Directions to “ VANIOLKY LOSADA LEON ” Practice Location

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