Provider Demographics
NPI:1982831988
Name:MIZRAHI, LEON (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:MIZRAHI
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 1:81767 DR CARREON BLVD
Mailing Address - Street 2:SUITE# 201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5597
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:1293 6TH ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1707
Practice Address - Country:US
Practice Address - Phone:760-391-5151
Practice Address - Fax:760-775-4181
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC41014208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics