Provider Demographics
NPI:1316347172
Name:LEONARDI, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:LEONARDI
Suffix:
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 1:4165 W 2200 N
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9309
Mailing Address - Country:US
Mailing Address - Phone:801-698-4863
Mailing Address - Fax:
Practice Address - Street 1:1435 VILLAGE DRIVE
Practice Address - Street 2:DEPT. 2801
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408
Practice Address - Country:US
Practice Address - Phone:801-698-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program