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General NPI Number Information
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NPI Number | 1801124052
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Entity Type | Organization
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Legal Business Name | ANGELO J. LEONI, M.D., A MEDICAL CORP
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 1116 B ST
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City | PETALUMA
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State | CA
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Zip | 94952-4054
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Country | US
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Telephone | 707-762-4583
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Fax | 707-762-2145
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Provider Business Mailing Address
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Address Line | 1116 B ST
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City | PETALUMA
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State | CA
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Zip | 94952-4054
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Country | US
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Telephone | 707-762-4583
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Fax | 707-762-2145
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANGELO J. LEONI
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Credential | M.D.
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Telephone | 707-762-4583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 00G1500
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License Number State | CA
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