Basic Information
| Provider Information | |||||||||
| NPI: | 1912100678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORMAN | ||||||||
| FirstName: | LEONE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 331580 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784631580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618887752 | ||||||||
| FaxNumber: | 3618887424 | ||||||||
| Practice Location | |||||||||
| Address1: | 2216 N 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785014002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566860032 | ||||||||
| FaxNumber: | 3618887424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225000000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter |
No ID Information.