Provider Demographics
NPI:1720029234
Name:LEON, NIDIA P (MD)
Entity Type:Individual
Prefix:MRS
First Name:NIDIA
Middle Name:P
Last Name:LEON
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 1:20403 ENCINO LEDGE UNIT 592716
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0873
Mailing Address - Country:US
Mailing Address - Phone:210-927-1832
Mailing Address - Fax:210-927-3426
Practice Address - Street 1:6100 BANDERA ROAD, STE 215
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238
Practice Address - Country:US
Practice Address - Phone:210-927-1832
Practice Address - Fax:210-927-3426
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7940207RP1001X
NV10012207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00202087Medicaid
NV37835Medicare ID - Type Unspecified
NVH90475Medicare UPIN