Healthcare Provider Details

I. General information

NPI: 1871023275
Provider Name (Legal Business Name): CONRADO DELEON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 CANTERBURY LN
MOSES LAKE WA
98837-1822
US

IV. Provider business mailing address

403 CANTERBURY LN
MOSES LAKE WA
98837-1822
US

V. Phone/Fax

Practice location:
  • Phone: 509-592-9921
  • Fax: 509-329-6141
Mailing address:
  • Phone: 509-592-9921
  • Fax: 509-329-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00024096
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00024096
License Number StateWA

VIII. Authorized Official

Name: MRS. JULIE ARRIAGA
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-592-9921