Healthcare Provider Details

I. General information

NPI: 1184746356
Provider Name (Legal Business Name): JONAH LEON CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SANTANA ROW SUITE 313
SAN JOSE CA
95128-2000
US

IV. Provider business mailing address

333 SANTANA ROW SUITE 313
SAN JOSE CA
95128-2000
US

V. Phone/Fax

Practice location:
  • Phone: 650-815-1920
  • Fax: 650-615-9995
Mailing address:
  • Phone: 650-815-1920
  • Fax: 650-615-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number029055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: