Provider Demographics
NPI:1457022105
Name:DE LEON, ILEANA GRACIELA
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:GRACIELA
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 1:11520 GREENWOOD AVE N APT 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8660
Mailing Address - Country:US
Mailing Address - Phone:206-334-2404
Mailing Address - Fax:
Practice Address - Street 1:11520 GREENWOOD AVE N APT 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8660
Practice Address - Country:US
Practice Address - Phone:206-334-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC56330171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter