Healthcare Provider Details

I. General information

NPI: 1548210990
Provider Name (Legal Business Name): LEON FRANCIS DEISERING CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W TARGET RANGE ROAD SUITE 102
NOGALES AZ
85621
US

IV. Provider business mailing address

PO BOX 819
NOGALES AZ
85628-0819
US

V. Phone/Fax

Practice location:
  • Phone: 520-287-4020
  • Fax: 520-287-2348
Mailing address:
  • Phone: 520-287-4020
  • Fax: 520-287-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN129422
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: