Healthcare Provider Details

I. General information

NPI: 1124912779
Provider Name (Legal Business Name): ERIK DE LEON CMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 SAN PABLO AVE APT C
BERKELEY CA
94702-2073
US

IV. Provider business mailing address

2521 SAN PABLO AVE APT C
BERKELEY CA
94702-2073
US

V. Phone/Fax

Practice location:
  • Phone: 650-888-3039
  • Fax:
Mailing address:
  • Phone: 650-888-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: