Healthcare Provider Details

I. General information

NPI: 1093982043
Provider Name (Legal Business Name): LEONIDAS ANDRES JOSE CENIZA YAUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E MAIN ST SUITE 104
NORTHVILLE MI
48167-2494
US

IV. Provider business mailing address

235 E MAIN ST SUITE 104
NORTHVILLE MI
48167-2494
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-5050
  • Fax:
Mailing address:
  • Phone: 248-349-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011673
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: