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NPI Code Detail

MEDICARE: DWIGHT AUSTIN SERGIO DE LEON CP61215033

MEDICARE: DWIGHT AUSTIN SERGIO DE LEON CP61215033
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP61215033WA

General Provider Information

NPI Number : 1811537277
Entity Type Code : Individual
Provider Name (Legal Business Name) : DWIGHT AUSTIN SERGIO DE LEON CP61215033
Provider Business Mailing Address
First Line : PO BOX 10157
Second Line :
City : SPOKANE
State : WA
Zip : 99209-1157
Country : US
Telephone Number : 503-702-8454
Fax Number :
Provider Business Practice Location Address
First Line : 1302 W GARDNER AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99201-2059
Country : US
Telephone Number : 509-503-6010
Fax Number : 509-474-9612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2020
Last Update Date : 02/02/2024

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