MEDICARE: ELLEN IMBER LEONARD M.D.

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	H0558	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	H0558	OTHER	TX	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1245211895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN IMBER LEONARD M.D.

Provider Business Mailing Address
First Line	:	134 ROCKHILL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2220
Country	:	US
Telephone Number	:	210-862-7963
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3005
Country	:	US
Telephone Number	:	210-347-3440
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	10/03/2024

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