Healthcare Provider Details

I. General information

NPI: 1689824310
Provider Name (Legal Business Name): MICHELLE MARIANNA LEON RN, MSN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MICHELLE MARIANNA LEON

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 EASTLAKE AVE
LOS ANGELES CA
90089-3012
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-3000
  • Fax:
Mailing address:
  • Phone: 323-442-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18449
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number18449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: