Healthcare Provider Details

I. General information

NPI: 1841365194
Provider Name (Legal Business Name): GUIDO LEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S TOLSHOR BLVD
LAS CRUCES NM
88011
US

IV. Provider business mailing address

1255 S TOLSHOR BLVD
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-0300
  • Fax: 505-522-4366
Mailing address:
  • Phone: 505-522-0300
  • Fax: 505-522-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number7955
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: