Healthcare Provider Details

I. General information

NPI: 1063081818
Provider Name (Legal Business Name): IRENE C LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 E 41ST ST
HIALEAH FL
33013-2455
US

IV. Provider business mailing address

1437 LANTANA DR
WESTON FL
33326-3601
US

V. Phone/Fax

Practice location:
  • Phone: 305-693-0441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19688
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number19668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: