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NPI Code Detail

MEDICARE: JESSICA LEANO

MEDICARE: JESSICA LEANO
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1992969000
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LEANO
Provider Business Mailing Address
First Line : 2708 NE 14TH ST APT 5
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-3564
Country : US
Telephone Number : 954-603-7885
Fax Number :
Provider Business Practice Location Address
First Line : 2708 NE 14TH ST APT 5
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-3564
Country : US
Telephone Number : 954-603-7885
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2008
Last Update Date : 07/17/2008

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Directions to “ JESSICA LEANO ” Practice Location

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