Provider Demographics
NPI:1427619873
Name:ROJAS CORTES, LEONARDO LEON
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:LEON
Last Name:ROJAS CORTES
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 1:1217 STONEWAY LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5664
Mailing Address - Country:US
Mailing Address - Phone:561-401-7155
Mailing Address - Fax:
Practice Address - Street 1:1217 STONEWAY LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-5664
Practice Address - Country:US
Practice Address - Phone:561-401-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-10850106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty