Provider Demographics
NPI:1083023741
Name:DE LEON, ANNIVER ESSEL GALVEZ
Entity Type:Individual
Prefix:MISS
First Name:ANNIVER ESSEL
Middle Name:GALVEZ
Last Name:DE LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10197 BACKWATER CV
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-7008
Mailing Address - Country:US
Mailing Address - Phone:415-676-0466
Mailing Address - Fax:
Practice Address - Street 1:814 CEDAR PKWY
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1200
Practice Address - Country:US
Practice Address - Phone:219-227-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011462A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation