Provider Demographics
NPI:1275862146
Name:MEALANCON, LEROY
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:
Last Name:MEALANCON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W PALMDALE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4230
Mailing Address - Country:US
Mailing Address - Phone:661-575-8395
Mailing Address - Fax:
Practice Address - Street 1:520 W PALMDALE BLVD STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4230
Practice Address - Country:US
Practice Address - Phone:661-575-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner