MEDICARE: SAMANTHA MONIQUE 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	104100000X	Social Worker	ASW122342	CA

General Provider Information

NPI Number	:	1952140675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MONIQUE LEON

Provider Business Mailing Address
First Line	:	3855 N WEST AVE STE 110
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-2759
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 N WEST AVE STE 110
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-2759
Country	:	US
Telephone Number	:	559-334-6433
Fax Number	:

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

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	03/04/2026

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