Individual
LEONARDO SANTIBANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2920 N 4TH ST, FLAGSTAFF, AZ 86004-1816
(928) 522-9400
Mailing address
901 W MACKENZIE DR, PHOENIX, AZ 85013-3014
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53923
NM
363LF0000X
Family Nurse Practitioner
AP11559
AZ
Other
Enumeration date
07/18/2018
Last updated
11/05/2018
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