MEDICARE: JAZMIN DOMINIQUE LEAL

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	390200000X	Student in an Organized Health Care Education/Training Program	242.018543	IL

General Provider Information

NPI Number	:	1841159175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMIN DOMINIQUE LEAL

Provider Business Mailing Address
First Line	:	24109 PILGRIM RD
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-9331
Country	:	US
Telephone Number	:	815-441-4055
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 E LE FEVRE RD
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1391
Country	:	US
Telephone Number	:	815-626-5050
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ JAZMIN DOMINIQUE LEAL ” Practice Location

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