MEDICARE: LESLIE PINTADO - SANTANA MS ED

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	390200000X	Student in an Organized Health Care Education/Training Program	1254182	NY

General Provider Information

NPI Number	:	1730542739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE PINTADO - SANTANA MS ED

Provider Business Mailing Address
First Line	:	1283 MACE AVE
Second Line	:	PH
City	:	BRONX
State	:	NY
Zip	:	10469-5623
Country	:	US
Telephone Number	:	646-377-7105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1283 MACE AVE
Second Line	:	PH
City	:	BRONX
State	:	NY
Zip	:	10469-5623
Country	:	US
Telephone Number	:	646-377-7105
Fax Number	:

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

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	03/29/2016

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