Provider Demographics
NPI:1043562788
Name:DE LEON, VICTOR OCTAVIO (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:OCTAVIO
Last Name:DE LEON
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2515
Mailing Address - Country:US
Mailing Address - Phone:626-812-0055
Mailing Address - Fax:
Practice Address - Street 1:326 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2515
Practice Address - Country:US
Practice Address - Phone:626-812-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-10-7513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-10-7513OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD