Provider Demographics
NPI:1821405903
Name:LEON, CRISTINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NW 12TH AVE
Mailing Address - Street 2:#5066
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-243-6631
Mailing Address - Fax:305-243-5978
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:#5066
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-6631
Practice Address - Fax:305-243-5978
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6891235Z00000X
FLSA14026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013405400Medicaid