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General NPI Number Information
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NPI Number | 1952836744
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Entity Type | Organization
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Legal Business Name | EDWIN ROMEL S. DE LEON, M.D., INC.
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 208 W HIGHLAND AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-4018
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Country | US
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Telephone | 909-886-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 208 W HIGHLAND AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-4018
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Country | US
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Telephone | 909-886-3100
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. EDWIN ROMEL SORIANO DE LEON
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Credential | M.D.
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Telephone | 714-992-5853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A118530
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License Number State | CA
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