Individual
MARVIN LEANDICHO DE LEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2369 N 142ND AVE, GOODYEAR, AZ 85395-1657
(623) 203-5500
Mailing address
2369 N 142ND AVE, GOODYEAR, AZ 85395-1657
(623) 203-5500
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP038083
AZ
Other
Enumeration date
07/27/2009
Last updated
07/27/2009
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