Provider Demographics
NPI:1023387438
Name:LEON, ALICIA G (REHS)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:G
Last Name:LEON
Suffix:
Gender:F
Credentials:REHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6020
Mailing Address - Country:US
Mailing Address - Phone:415-575-5670
Mailing Address - Fax:415-575-5799
Practice Address - Street 1:30 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6020
Practice Address - Country:US
Practice Address - Phone:415-575-5670
Practice Address - Fax:415-575-5799
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6237171R00000X
171R00000X, 246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory