Provider Demographics
NPI:1245686187
Name:LEON, ALICIA SERNA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:SERNA
Last Name:LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 W PAUL BOND DR APT C202
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1755
Mailing Address - Country:US
Mailing Address - Phone:520-415-4491
Mailing Address - Fax:
Practice Address - Street 1:580 N MORLEY AVE
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2936
Practice Address - Country:US
Practice Address - Phone:520-415-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ376K00000X376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide