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General NPI Number Information
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NPI Number | 1043698509
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Entity Type | Individual
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Provider Name | DARLENE LEON
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Gender | Female
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 13757 ASPEN LEAF LN
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City | CORONA
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State | CA
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Zip | 92880-0721
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Country | US
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Telephone | 951-777-8775
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Fax | 951-220-7178
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Provider Business Mailing Address
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Address Line | 19069 VAN BUREN BLVD 114-116
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City | RIVERSIDE
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State | CA
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Zip | 92508-9169
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Country | US
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Telephone | 951-777-8775
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Fax | 951-220-7178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 4722559913
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License Number State | CA
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