MEDICARE: MS. LYDIANA DE LEON

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	225C00000X	Rehabilitation Counselor		FL

General Provider Information

NPI Number	:	1144168493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYDIANA DE LEON

Provider Business Mailing Address
First Line	:	12602 DOUBLE BRIDLE CT APT 301
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-2522
Country	:	US
Telephone Number	:	813-847-4748
Fax Number	:

Provider Business Practice Location Address
First Line	:	12602 DOUBLE BRIDLE CT APT 301
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-2522
Country	:	US
Telephone Number	:	813-847-4748
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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