Provider Demographics
NPI:1942253299
Name:LEON, LEONARD RUDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:RUDOLPH
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 W CAPE FINAL TRL
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-5068
Mailing Address - Country:US
Mailing Address - Phone:520-638-6447
Mailing Address - Fax:
Practice Address - Street 1:280 SIERRA COLLEGE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-273-8486
Practice Address - Fax:530-271-0505
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32693207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G326930Medicaid
CAA45250Medicare UPIN
CA00G326930Medicaid