Provider Demographics
NPI:1457181562
Name:MATOS, LEONARDO JR
Entity type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:
Last Name:MATOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2113
Mailing Address - Country:US
Mailing Address - Phone:330-651-6667
Mailing Address - Fax:
Practice Address - Street 1:22 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2113
Practice Address - Country:US
Practice Address - Phone:267-600-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3062HHN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health