MEDICARE: DR. GINGER LINA LEON D.O.

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	207Q00000X	Family Medicine Physician	20A 8311	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FL767Y	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1245234780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINGER LINA LEON D.O.

Provider Business Mailing Address
First Line	:	5404 MORENO ST
Second Line	:	STE. N
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1667
Country	:	US
Telephone Number	:	909-949-4400
Fax Number	:	909-949-4441

Provider Business Practice Location Address
First Line	:	5404 MORENO ST
Second Line	:	STE. N
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1667
Country	:	US
Telephone Number	:	909-949-4400
Fax Number	:	909-949-4441

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	12/15/2014

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