Provider Demographics
NPI:1427321322
Name:LEON, NOELLE ANGELICA
Entity type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:ANGELICA
Last Name:LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22799 DESOTO STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313
Mailing Address - Country:US
Mailing Address - Phone:909-783-4401
Mailing Address - Fax:
Practice Address - Street 1:22799 DESOTO STREET
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313
Practice Address - Country:US
Practice Address - Phone:909-783-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy