Provider Demographics
NPI:1265486070
Name:LEON, SAMUEL O (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:O
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W GRANGEVILLE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2866
Mailing Address - Country:US
Mailing Address - Phone:559-583-1110
Mailing Address - Fax:559-583-1121
Practice Address - Street 1:560 W GRANGEVILLE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2866
Practice Address - Country:US
Practice Address - Phone:559-583-1110
Practice Address - Fax:559-583-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH58582Medicare UPIN
BY384ZMedicare PIN