Provider Demographics
NPI:1164146916
Name:LEON DELGADO, CARMEN PAOLA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:PAOLA
Last Name:LEON DELGADO
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 1:840 BOURN DR SPC 67
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4987
Mailing Address - Country:US
Mailing Address - Phone:530-554-3966
Mailing Address - Fax:
Practice Address - Street 1:840 BOURN DR SPC 67
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4987
Practice Address - Country:US
Practice Address - Phone:530-554-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program