Provider Demographics
NPI:1356007892
Name:DE LEON, STEPHANIE (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STEPHANIE RODRIGUEZ
Mailing Address - Street 1:512 E MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92314-9459
Mailing Address - Country:US
Mailing Address - Phone:909-728-3911
Mailing Address - Fax:
Practice Address - Street 1:512 E MEADOW LN
Practice Address - Street 2:
Practice Address - City:BIG BEAR CITY
Practice Address - State:CA
Practice Address - Zip Code:92314-9459
Practice Address - Country:US
Practice Address - Phone:909-728-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist