Provider Demographics
NPI:1568587087
Name:LEON MEDICAL CENTERS LLC
Entity Type:Organization
Organization Name:LEON MEDICAL CENTERS LLC
Other - Org Name:LEON MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:305-631-4427
Mailing Address - Street 1:8600 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6202
Mailing Address - Country:US
Mailing Address - Phone:305-642-5366
Mailing Address - Fax:
Practice Address - Street 1:2020 W 64TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2607
Practice Address - Country:US
Practice Address - Phone:305-631-5924
Practice Address - Fax:305-646-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
FLPH223803336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023821OtherNCPDP PROVIDER IDENTIFICATION NUMBER