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General NPI Number Information
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NPI Number | 1629398490
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Entity Type | Individual
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Provider Name | JACQUELINE MARIE LEON LEON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 25500 RANCHO NIGUEL RD STE 110
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7373
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Country | US
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Telephone | 949-448-8821
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Fax | 949-448-8831
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Provider Business Mailing Address
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Address Line | 24422 AVENIDA DE LA CARLOTA STE 300
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3628
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Country | US
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Telephone | 949-599-2423
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Fax | 949-599-2430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A111658
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License Number State | CA
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