Basic Information
| Provider Information | |||||||||
| NPI: | 1740574136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEON | ||||||||
| FirstName: | ALEJANDRO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3102 COMMERCE PKWY | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330253943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058165800 | ||||||||
| FaxNumber: | 3058165844 | ||||||||
| Practice Location | |||||||||
| Address1: | 3102 COMMERCE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058165800 | ||||||||
| FaxNumber: | 3058165844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2011 | ||||||||
| LastUpdateDate: | 06/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND 5725 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.