Provider Demographics
NPI:1851600597
Name:LEON-URIBE, DENISSE (MED)
Entity Type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:LEON-URIBE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DENISSE
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3153
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-3153
Mailing Address - Country:US
Mailing Address - Phone:928-261-9602
Mailing Address - Fax:
Practice Address - Street 1:3689 W PAGEANT PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3262
Practice Address - Country:US
Practice Address - Phone:928-341-6041
Practice Address - Fax:928-341-6099
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool