Healthcare Provider Details

I. General information

NPI: 1720612369
Provider Name (Legal Business Name): RYAN ANDREW DE LEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

10089 ROAD 5.6 NE
MOSES LAKE WA
98837-7500
US

V. Phone/Fax

Practice location:
  • Phone: 480-342-2000
  • Fax:
Mailing address:
  • Phone: 509-760-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number79742
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: