Provider Demographics
NPI:1467423640
Name:MADERAZO, LEONOR ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:ALEJANDRO
Last Name:MADERAZO
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 1:2901 NORTH CENTRAL AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2738
Mailing Address - Country:US
Mailing Address - Phone:602-744-4765
Mailing Address - Fax:602-744-4799
Practice Address - Street 1:2901 NORTH CENTRAL AVE
Practice Address - Street 2:STE 500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2738
Practice Address - Country:US
Practice Address - Phone:602-744-4765
Practice Address - Fax:602-744-4799
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9642207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232497Medicaid
D37220Medicare UPIN
AZ05WCHKJ01Medicare ID - Type Unspecified