Healthcare Provider Details

I. General information

NPI: 1992934327
Provider Name (Legal Business Name): JOCELYN BALMORES DELEON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

IV. Provider business mailing address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-2641
  • Fax: 269-201-2855
Mailing address:
  • Phone: 269-349-2641
  • Fax: 269-201-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301094382
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301094382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: