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NPI Code Detail

MEDICARE: MR. PHILLIP I LEON RN

MEDICARE: MR. PHILLIP I LEON RN
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
1163W00000XRegistered Nurse482743CA

General Provider Information

NPI Number : 1194855130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILLIP I LEON RN
Provider Business Mailing Address
First Line : 3905 MAIN ST
Second Line :
City : CHULA VISTA
State : CA
Zip : 91911
Country : US
Telephone Number : 619-446-8281
Fax Number : 619-595-7927
Provider Business Practice Location Address
First Line : 3177 OCEAN VIEW BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-1432
Country : US
Telephone Number : 619-446-8281
Fax Number : 619-595-7927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 05/16/2011

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