MEDICARE: GRACE LEONARDO 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	208000000X	Pediatrics Physician	L6098	TX

General Provider Information

NPI Number	:	1700832763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE LEONARDO MD

Provider Business Mailing Address
First Line	:	13114 FM 1960 RD W
Second Line	:	114
City	:	HOUSTON
State	:	TX
Zip	:	77065-4290
Country	:	US
Telephone Number	:	281-469-2838
Fax Number	:	281-469-2247

Provider Business Practice Location Address
First Line	:	13114 FM 1960 RD W
Second Line	:	114
City	:	HOUSTON
State	:	TX
Zip	:	77065-4290
Country	:	US
Telephone Number	:	281-469-2838
Fax Number	:	281-469-2247

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/03/2011

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Directions to “ GRACE LEONARDO MD” Practice Location

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