Healthcare Provider Details

I. General information

NPI: 1093837064
Provider Name (Legal Business Name): MARIA CRISTINA S. DE LEON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N IMPERIAL AVE
IMPERIAL CA
92251-1398
US

IV. Provider business mailing address

1600 N IMPERIAL AVE
IMPERIAL CA
92251-1398
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-9951
  • Fax: 760-344-6128
Mailing address:
  • Phone: 818-297-6697
  • Fax: 818-240-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: