Healthcare Provider Details

I. General information

NPI: 1083977201
Provider Name (Legal Business Name): ARCHANGEL DE LEON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7466 SUN CASTLE LN
SACRAMENTO CA
95823-6734
US

IV. Provider business mailing address

7466 SUN CASTLE LN
SACRAMENTO CA
95823-6734
US

V. Phone/Fax

Practice location:
  • Phone: 510-434-4100
  • Fax:
Mailing address:
  • Phone: 510-434-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC 40823
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC 40823
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC 40823
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberC 40823
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC 40823
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC 40823
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC 40823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: