Healthcare Provider Details

I. General information

NPI: 1316062375
Provider Name (Legal Business Name): DEBRA DELEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 300
GARDENA CA
90248-4223
US

IV. Provider business mailing address

879 W 190TH ST STE 300
GARDENA CA
90248-4223
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: