Healthcare Provider Details

I. General information

NPI: 1366501751
Provider Name (Legal Business Name): AURELIA CYNTHIA DE LEON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VILLA AVE STE 3
CLOVIS CA
93612-0899
US

IV. Provider business mailing address

516 VILLA AVE STE 3
CLOVIS CA
93612-0899
US

V. Phone/Fax

Practice location:
  • Phone: 559-288-9508
  • Fax:
Mailing address:
  • Phone: 559-288-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT48518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: