Provider Demographics
NPI:1346865540
Name:LEON, YULISSA (AMA)
Entity Type:Individual
Prefix:MISS
First Name:YULISSA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:AMA
Other - Prefix:
Other - First Name:YULISSA
Other - Middle Name:
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMA
Mailing Address - Street 1:78 RODONDO AVE
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1745
Mailing Address - Country:US
Mailing Address - Phone:707-880-1010
Mailing Address - Fax:
Practice Address - Street 1:78 RODONDO AVE
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-1745
Practice Address - Country:US
Practice Address - Phone:707-880-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant