Individual
IDALMA MAZARIEGOS DE LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
430 NIAGARA ST, BUFFALO, NY 14201-1886
(716) 247-8336
Mailing address
193 WALTER AVE, TONAWANDA, NY 14150-4035
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/22/2016
Last updated
12/22/2016
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