Healthcare Provider Details

I. General information

NPI: 1104286608
Provider Name (Legal Business Name): ALEX DELEON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 06/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E LIVINGSTON AVE
COLUMBUS OH
43215-5533
US

IV. Provider business mailing address

431 E LIVINGSTON AVE
COLUMBUS OH
43215-5533
US

V. Phone/Fax

Practice location:
  • Phone: 146-227-9420
  • Fax: 614-334-3234
Mailing address:
  • Phone: 146-227-9420
  • Fax: 614-334-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: