MEDICARE: DR. MANUEL ANTONIO DELEON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN12447	FL
2	122300000X	Dentist	30997	CA

General Provider Information

NPI Number	:	1023205143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL ANTONIO DELEON DDS

Provider Business Mailing Address
First Line	:	7963 VAN NUYS BLVD STE 103
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-6071
Country	:	US
Telephone Number	:	818-895-1458
Fax Number	:	818-780-1538

Provider Business Practice Location Address
First Line	:	7963 VAN NUYS BLVD STE 103
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-6071
Country	:	US
Telephone Number	:	818-895-1458
Fax Number	:	818-780-1538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	09/27/2018

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