MEDICARE: NAOMI DAWN LEON-GUERRERO

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		WA
2	207R00000X	Internal Medicine Physician	8481704	ID
3	208M00000X	Hospitalist Physician	8481704	ID

General Provider Information

NPI Number	:	1962106179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI DAWN LEON-GUERRERO

Provider Business Mailing Address
First Line	:	1301 S CARNAHAN RD APT A407
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-3292
Country	:	US
Telephone Number	:	808-382-4866
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 E FRONT AVE, SPOKANE, WA 99202
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99212-9921
Country	:	US
Telephone Number	:	509-626-9900
Fax Number	:

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

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	06/09/2026

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