MEDICARE: MAGNIE LAZARA LEDESMA LEON MD

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	104100000X	Social Worker
2	208D00000X	General Practice Physician	ME165580	FL
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207R00000X	Internal Medicine Physician	ME165580	FL

General Provider Information

NPI Number	:	1174849749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGNIE LAZARA LEDESMA LEON MD

Provider Business Mailing Address
First Line	:	2001 W 68TH ST STE 202
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1898
Country	:	US
Telephone Number	:	305-364-2107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 W 68TH ST STE 202
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1898
Country	:	US
Telephone Number	:	305-364-2107
Fax Number	:

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

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	08/02/2025

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