Provider Demographics
NPI:1639712466
Name:LEONES, LINDA MARITZA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARITZA
Last Name:LEONES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 N RANDOLPH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1408
Mailing Address - Country:US
Mailing Address - Phone:786-531-3795
Mailing Address - Fax:
Practice Address - Street 1:1653 THE FAIRWAY STE 216
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1420
Practice Address - Country:US
Practice Address - Phone:215-234-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty