MEDICARE: NIDIA IRENE LEON

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	235Z00000X	Speech-Language Pathologist	28925	CA

General Provider Information

NPI Number	:	1982097507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDIA IRENE LEON

Provider Business Mailing Address
First Line	:	15528 CORDARY AVE
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3527
Country	:	US
Telephone Number	:	424-244-2613
Fax Number	:

Provider Business Practice Location Address
First Line	:	15528 CORDARY AVE
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3527
Country	:	US
Telephone Number	:	424-244-2613
Fax Number	:

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

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	01/18/2026

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Directions to “ NIDIA IRENE LEON ” Practice Location

Language	Start Address	Practice Location

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