Provider Demographics
NPI:1225233257
Name:LEONARDO, MYRIAM RICHARDSON (MD)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:RICHARDSON
Last Name:LEONARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CALLE LUNA
Mailing Address - Street 2:URB. LOS ANGELES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1608
Mailing Address - Country:US
Mailing Address - Phone:787-791-7229
Mailing Address - Fax:
Practice Address - Street 1:113 CALLE LUNA
Practice Address - Street 2:URB. LOS ANGELES
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-1608
Practice Address - Country:US
Practice Address - Phone:787-791-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2426202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner