MEDICARE: LEON MEDICAL LLC

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	:	1457201147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEON MEDICAL LLC

Provider Business Mailing Address
First Line	:	3621 CANTABELLA CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0827
Country	:	US
Telephone Number	:	702-703-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 CANTABELLA CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0827
Country	:	US
Telephone Number	:	702-703-9070
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMAURI SANTIAGO ROSALES PONCE DE LEON
Credential	:	NP
Telephone Number	:	702-703-9070

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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