Provider Demographics
NPI:1497791214
Name:LEON, ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
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 1:3400 DATA DRIVE
Mailing Address - Street 2:CHW MEDICAL FOUNDATION
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2911
Mailing Address - Fax:916-859-2911
Practice Address - Street 1:3132 WEST MARCH LANE, SUITE 5
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2354
Practice Address - Country:US
Practice Address - Phone:209-475-5500
Practice Address - Fax:208-475-5535
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110011810OtherRR MEDICARE
00A206850OtherBLUE SHIELD
CA00A206850Medicaid
110011810OtherRR MEDICARE
CA00A206850Medicare ID - Type Unspecified