Healthcare Provider Details

I. General information

NPI: 1912100678
Provider Name (Legal Business Name): LEONE DORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 N 10TH ST
MCALLEN TX
78501-4002
US

IV. Provider business mailing address

PO BOX 331580
CORPUS CHRISTI TX
78463-1580
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-0032
  • Fax: 361-888-7424
Mailing address:
  • Phone: 361-888-7752
  • Fax: 361-888-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: