Provider Demographics
NPI:1699366047
Name:LEON, MONICA CAROLINA (MA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:CAROLINA
Last Name:LEON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 MOUNTAIN VISTA ST APT 2112
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2371
Mailing Address - Country:US
Mailing Address - Phone:725-244-5674
Mailing Address - Fax:
Practice Address - Street 1:2785 E DESERT INN RD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3624
Practice Address - Country:US
Practice Address - Phone:725-206-5434
Practice Address - Fax:888-902-1744
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty