Healthcare Provider Details

I. General information

NPI: 1013703875
Provider Name (Legal Business Name): MARIA JOSE MORENO LEIGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR # 212
MOBILE AL
36617-2300
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR # 212
MOBILE AL
36617-2300
US

V. Phone/Fax

Practice location:
  • Phone: 251-434-3915
  • Fax: 251-415-1387
Mailing address:
  • Phone: 251-445-8282
  • Fax: 251-445-8281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL.6521
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: