MEDICARE: MARY LEONEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95149697	CA

General Provider Information

NPI Number	:	1083239628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LEONEN

Provider Business Mailing Address
First Line	:	9586 CARROLL CANYON RD APT 161
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4948
Country	:	US
Telephone Number	:	858-609-9679
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 OVERLAND AVE STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1261
Country	:	US
Telephone Number	:	858-694-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	08/12/2020

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Directions to “ MARY LEONEN ” Practice Location

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