Healthcare Provider Details

I. General information

NPI: 1982255857
Provider Name (Legal Business Name): EVETTE MARIE DELEON CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 CIELO AZUL WAY
DESERT HOT SPRINGS CA
92240-6235
US

IV. Provider business mailing address

13525 CIELO AZUL WAY
DESERT HOT SPRINGS CA
92240-6235
US

V. Phone/Fax

Practice location:
  • Phone: 760-329-4673
  • Fax:
Mailing address:
  • Phone: 760-329-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number26-1718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: