Provider Demographics
NPI:1063002731
Name:DE LEON, RUEL ALLAN REYES (R1415700121)
Entity Type:Individual
Prefix:MR
First Name:RUEL ALLAN
Middle Name:REYES
Last Name:DE LEON
Suffix:
Gender:M
Credentials:R1415700121
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S WESTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2906
Mailing Address - Country:US
Mailing Address - Phone:213-483-9201
Mailing Address - Fax:213-382-0136
Practice Address - Street 1:360 S WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2906
Practice Address - Country:US
Practice Address - Phone:213-483-9201
Practice Address - Fax:213-382-0136
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1415700121101Y00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor