Healthcare Provider Details

I. General information

NPI: 1417004987
Provider Name (Legal Business Name): RICK DELEON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 NEWCASTLE AVE APT 320
ENCINO CA
91316-2174
US

IV. Provider business mailing address

5501 NEWCASTLE AVE APT 320
ENCINO CA
91316-2174
US

V. Phone/Fax

Practice location:
  • Phone: 818-757-1675
  • Fax:
Mailing address:
  • Phone: 818-757-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: