Healthcare Provider Details

I. General information

NPI: 1609917996
Provider Name (Legal Business Name): LEONEL REZIL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COLUMBIA RD
DORCHESTER MA
02125-2322
US

IV. Provider business mailing address

10 RUXTON RD
MATTAPAN MA
02126-1114
US

V. Phone/Fax

Practice location:
  • Phone: 617-287-8000
  • Fax: 617-282-7603
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number212782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: