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: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 E THOUSAND OAKS BLVD
THOUSAND OAKS CA
91360-5707
US

IV. Provider business mailing address

1203 FLYNN RD UNIT 160
CAMARILLO CA
93012-6203
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-4574
  • Fax: 805-379-4324
Mailing address:
  • Phone: 805-804-4168
  • Fax: 805-830-1177

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: