Provider Demographics
NPI:1457449308
Name:DELEON, ENRIQUE (PAC)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:DELEON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 GRAND TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313
Mailing Address - Country:US
Mailing Address - Phone:661-716-9400
Mailing Address - Fax:661-716-9415
Practice Address - Street 1:2701 CHESTER AVE
Practice Address - Street 2:HIGHGROVE MEDICAL CENTER
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-326-1600
Practice Address - Fax:661-716-2613
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13722207R00000X
CADEAMD0560195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S51215Medicare UPIN