MEDICARE: LEAP PEDIATRIC AND ADOLESCENT CARE

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1457082919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAP PEDIATRIC AND ADOLESCENT CARE

Provider Business Mailing Address
First Line	:	1747 SUMMIT AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1833
Country	:	US
Telephone Number	:	651-242-2849
Fax Number	:

Provider Business Practice Location Address
First Line	:	1747 SUMMIT AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1833
Country	:	US
Telephone Number	:	651-242-2849
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND FOUNDER
Name	:	DR. JULIA JOSEPH-DI CAPRIO
Credential	:	MD
Telephone Number	:	651-242-2849

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	06/27/2022

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Directions to “LEAP PEDIATRIC AND ADOLESCENT CARE ” Practice Location

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