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1033614029 NPI number — ANDRES ALBERTO LEOS

NPI Number: 1033614029
Health Care Provider/Practitioner: ANDRES ALBERTO LEOS

Information about “1033614029” NPI (ANDRES ALBERTO LEOS) exists in 1033614029 in HTML format HTML  |  1033614029 in plain Text format TXT  |  1033614029 in PDF (Portable Document Format) PDF  |  1033614029 in an XML format XML  formats.

NPI Number : 1033614029 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033614029",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEOS",
    "FirstName": "ANDRES",
    "MiddleName": "ALBERTO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2333 JULIETTE LOW DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EL PASO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "79936-4095",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "915-319-0787",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2409 UNIVERSITY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUSTIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78712-1112",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-471-1737",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/29/2018",
    "LastUpdateDate": "03/29/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "390200000X",
        "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
        "LicenseNumber": "35462",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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