Healthcare Provider Details

I. General information

NPI: 1174251805
Provider Name (Legal Business Name): ANA D DE LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E LAS TUNAS DR
SAN GABRIEL CA
91776-1404
US

IV. Provider business mailing address

1515 W 190TH ST STE 300
GARDENA CA
90248-4925
US

V. Phone/Fax

Practice location:
  • Phone: 626-270-1317
  • Fax: 626-270-4266
Mailing address:
  • Phone: 310-819-4523
  • Fax: 877-394-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: