Provider Demographics
NPI:1730344102
Name:DE LEONNI STANONIK, MATEJA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MATEJA
Middle Name:
Last Name:DE LEONNI STANONIK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 E SKYLINE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-8013
Mailing Address - Country:US
Mailing Address - Phone:520-638-5757
Mailing Address - Fax:520-447-5701
Practice Address - Street 1:2850 E SKYLINE DR STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8013
Practice Address - Country:US
Practice Address - Phone:520-638-5757
Practice Address - Fax:520-447-5701
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ476752084N0400X
DC172593207R00000X
NE265142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ878694Medicaid
AZZ162803Medicare PIN