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General NPI Number Information
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NPI Number | 1841159175
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Entity Type | Individual
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Provider Name | JAZMIN DOMINIQUE LEAL
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Gender | Female
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 410 E LE FEVRE RD
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City | STERLING
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State | IL
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Zip | 61081-1391
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Country | US
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Telephone | 815-626-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 24109 PILGRIM RD
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City | STERLING
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State | IL
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Zip | 61081-9331
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Country | US
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Telephone | 815-441-4055
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 242.018543
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License Number State | IL
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