Provider Demographics
NPI:1598383929
Name:CRISTINA LEON, DO PA
Entity Type:Organization
Organization Name:CRISTINA LEON, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-251-5247
Mailing Address - Street 1:9927 WEST GIBSON JACK ROAD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204
Mailing Address - Country:US
Mailing Address - Phone:208-251-5247
Mailing Address - Fax:208-820-7004
Practice Address - Street 1:IDAHO FALLS PEDIATRICS
Practice Address - Street 2:3067 EAGLE DR
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406
Practice Address - Country:US
Practice Address - Phone:208-251-5247
Practice Address - Fax:208-820-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty