Provider Demographics
NPI:1295591006
Name:LEON, MARY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:LEON
Suffix:
Gender:F
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5101
Mailing Address - Country:US
Mailing Address - Phone:510-437-5999
Mailing Address - Fax:
Practice Address - Street 1:1 EAGLE RD
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5101
Practice Address - Country:US
Practice Address - Phone:510-437-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical