1033368402 NPI number — JOSE MARIO LEON-FRIAS DDS MSCD

Table of content: JOSE MARIO LEON-FRIAS DDS MSCD (NPI 1033368402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033368402 NPI number — JOSE MARIO LEON-FRIAS DDS MSCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEON-FRIAS
Provider First Name:
JOSE
Provider Middle Name:
MARIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS MSCD
Provider Gender Code:
M

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:
1033368402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOGALES
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85628-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
11-526-4441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA LOPEZ MATEOS 171-2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOGALES
Provider Business Practice Location Address State Name:
SONORA
Provider Business Practice Location Address Postal Code:
84000
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
011526313125544
Provider Business Practice Location Address Fax Number:
011526313125545
Provider Enumeration Date:
09/10/2008

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: 1223G0001X , with the licence number:  1072837 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: AEIE06429 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MXN000070 . This is a "SOUTHWEST SERVICE ADMINISTRATORS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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