Healthcare Provider Details

I. General information

NPI: 1679105969
Provider Name (Legal Business Name): JESSICA MARIE LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W SHAW LN STE 104
FRESNO CA
93711-2777
US

IV. Provider business mailing address

2570 JENSEN AVE STE 107
SANGER CA
93657-2269
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-4800
  • Fax:
Mailing address:
  • Phone: 559-977-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: