Healthcare Provider Details

I. General information

NPI: 1114030095
Provider Name (Legal Business Name): HUGO A. LEON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S G ST
SAN BERNARDINO CA
92410-3320
US

IV. Provider business mailing address

250 S G ST
SAN BERNARDINO CA
92410-3320
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax: 909-382-7101
Mailing address:
  • Phone: 909-382-7100
  • Fax: 909-382-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-2279
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA96477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: