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General NPI Number Information
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NPI Number | 1215122486
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Entity Type | Organization
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Legal Business Name | DEBORAH DELEON
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 3714 MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94619-1330
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Country | US
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Telephone | 510-530-2330
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Fax | 510-530-4947
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Provider Business Mailing Address
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Address Line | 3714 MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94619-1330
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Country | US
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Telephone | 510-530-2330
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Fax | 510-530-4947
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Authorized Official
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Title or Position | OPTOMETRIST/SOLE PROPRIETOR
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Name | DR. DEBORAH ELLEN DELEON
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Credential | OD
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Telephone | 510-530-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11046T
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License Number State | CA
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