Active NPI
Leydis Mourlot Leon
- Family Medicine Physician
- El Mirage, AZ
National Provider Identifier
1679366611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 117102
- Practice address
- 12481 W Via Camille
El Mirage, AZ 85335-5939 - Phone
- (786) 262-5490
- NPI assigned
- May 23, 2025
- Last updated
- May 23, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 117102 | ZZ | Primary |
| Internal Medicine Physician | 207R00000X | 117102 | ZZ |
Addresses
Primary practice location
12481 W Via Camille
El Mirage, AZ 85335-5939
Mailing address
12481 W Via Camille
El Mirage, AZ 85335-5939
Phone (786) 262-5490
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117102 | ZZ | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747958400000",
"number": "1679366611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12481 W VIA CAMILLE",
"city": "EL MIRAGE",
"state": "AZ",
"postal_code": "853355939",
"telephone_number": "786-262-5490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12481 W VIA CAMILLE",
"city": "EL MIRAGE",
"state": "AZ",
"postal_code": "853355939",
"telephone_number": "786-262-5490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOURLOT LEON",
"first_name": "LEYDIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-23",
"last_updated": "2025-05-23",
"certification_date": "2025-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ZZ",
"license": "117102",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "ZZ",
"license": "117102",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Mirage, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.