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General NPI Number Information
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NPI Number | 1528895182
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Entity Type | Individual
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Provider Name | GINNO DE LEON PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1500 N PRIEST DR # 109
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City | TEMPE
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State | AZ
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Zip | 85288-1213
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Country | US
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Telephone | 702-589-4871
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Fax |
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Provider Business Mailing Address
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Address Line | 14894 W VALENTINE ST
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City | SURPRISE
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State | AZ
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Zip | 85379-4277
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Country | US
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Telephone | 480-278-5842
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 314334
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License Number State | AZ
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