Healthcare Provider Details

I. General information

NPI: 1720769110
Provider Name (Legal Business Name): VALERIA DE LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2757 GREEN SPRINGS HWY
BIRMINGHAM AL
35209-4903
US

IV. Provider business mailing address

2010 3RD AVE S APT 551C
BIRMINGHAM AL
35233-2190
US

V. Phone/Fax

Practice location:
  • Phone: 858-405-1705
  • Fax:
Mailing address:
  • Phone: 858-405-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD.007513-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: