Provider Demographics
NPI:1952804304
Name:LEON, JOSE IGNACIO (INTERNATIONAL MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:IGNACIO
Last Name:LEON
Suffix:
Gender:M
Credentials:INTERNATIONAL MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 ELDRON DR APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7134
Mailing Address - Country:US
Mailing Address - Phone:786-301-1326
Mailing Address - Fax:
Practice Address - Street 1:470 ELDRON DR APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7134
Practice Address - Country:US
Practice Address - Phone:786-301-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-527246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant