1568627123 NPI number — DR. ANGELA PATRICIA LEON - HERNANDEZ M.D.

Table of content: DR. ANGELA PATRICIA LEON - HERNANDEZ M.D. (NPI 1568627123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568627123 NPI number — DR. ANGELA PATRICIA LEON - HERNANDEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEON - HERNANDEZ
Provider First Name:
ANGELA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568627123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 GARDEN VIEW DR NE
Provider Second Line Business Mailing Address:
APARTMENT 1216
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30319-5825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-884-2179
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 JESSE HILL JR DR SE
Provider Second Line Business Practice Location Address:
SUITE 316
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-727-5772
Provider Business Practice Location Address Fax Number:
404-727-7094
Provider Enumeration Date:
07/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , with the licence number:  72332 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112333100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".