Healthcare Provider Details

I. General information

NPI: 1700723665
Provider Name (Legal Business Name): JESEY HERNANDEZ LEON SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 W 9TH ST APT 1A
HIALEAH FL
33010-4001
US

IV. Provider business mailing address

179 W 9TH ST APT 1A
HIALEAH FL
33010-4001
US

V. Phone/Fax

Practice location:
  • Phone: 813-403-1715
  • Fax:
Mailing address:
  • Phone: 813-403-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number23-758
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: