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General NPI Number Information
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NPI Number | 1700119195
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Entity Type | Individual
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Provider Name | MIA DE LEON NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 960 S WESTLAKE BLVD STE 208
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3162
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Country | US
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Telephone | 805-379-5970
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Fax | 805-379-5211
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Provider Business Mailing Address
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Address Line | 960 S WESTLAKE BLVD STE 208
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3162
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Country | US
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Telephone | 805-379-5970
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Fax | 805-379-5211
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CA497626
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | NP9810
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License Number State | CA
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