Provider Demographics
NPI:1154123628
Name:LEON-SEIDBERG, FRIDA
Entity type:Individual
Prefix:
First Name:FRIDA
Middle Name:
Last Name:LEON-SEIDBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 W MEDLOCK DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2129
Mailing Address - Country:US
Mailing Address - Phone:602-478-9406
Mailing Address - Fax:
Practice Address - Street 1:3700 N 24TH ST STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6526
Practice Address - Country:US
Practice Address - Phone:602-903-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0139862081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine