MEDICARE: LEONARDO ARTURO LONGORIA 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	207V00000X	Obstetrics & Gynecology Physician	R1407	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R1407	OTHER	TX	TEXAS MEDICAL LICENSE

General Provider Information

NPI Number	:	1558689554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARDO ARTURO LONGORIA M.D.

Provider Business Mailing Address
First Line	:	1404 LOST PADRE MINE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-2820
Country	:	US
Telephone Number	:	915-526-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000B TRANS MOUNTAIN RD STE 260
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3600
Country	:	US
Telephone Number	:	915-328-4793
Fax Number	:	915-591-9215

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

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	07/21/2022

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Directions to “ LEONARDO ARTURO LONGORIA M.D.” Practice Location

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