MEDICARE: ALFREDO LEON M.D.

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	207R00000X	Internal Medicine Physician	A20685	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110011810	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00A206850	OTHER		BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497791214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFREDO LEON M.D.

Provider Business Mailing Address
First Line	:	3400 DATA DRIVE
Second Line	:	CHW MEDICAL FOUNDATION
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:	916-379-2911
Fax Number	:	916-859-2911

Provider Business Practice Location Address
First Line	:	3132 WEST MARCH LANE, SUITE 5
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-2354
Country	:	US
Telephone Number	:	209-475-5500
Fax Number	:	208-475-5535

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/29/2012

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Directions to “ ALFREDO LEON M.D.” Practice Location

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