Provider Demographics
NPI:1245234780
Name:LEON, GINGER LINA (DO)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:LINA
Last Name:LEON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5404 MORENO ST
Mailing Address - Street 2:STE. N
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1667
Mailing Address - Country:US
Mailing Address - Phone:909-949-4400
Mailing Address - Fax:909-949-4441
Practice Address - Street 1:5404 MORENO ST
Practice Address - Street 2:STE. N
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1667
Practice Address - Country:US
Practice Address - Phone:909-949-4400
Practice Address - Fax:909-949-4441
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 8311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFL767YOtherMEDICARE PTAN
CAH99561Medicare UPIN