Healthcare Provider Details

I. General information

NPI: 1700533767
Provider Name (Legal Business Name): ALEJANDRO ANTONIO LEON MADRAZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3894
US

IV. Provider business mailing address

34 MAPLE ST
NORWALK CT
06850-3894
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-3122
  • Fax:
Mailing address:
  • Phone: 203-852-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: