Provider Demographics
NPI:1467418830
Name:LEON, RONALD LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LAWRENCE
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3432 HILLCREST AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6301
Mailing Address - Country:US
Mailing Address - Phone:925-778-1444
Mailing Address - Fax:925-778-9014
Practice Address - Street 1:3432 HILLCREST AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6301
Practice Address - Country:US
Practice Address - Phone:925-778-1444
Practice Address - Fax:925-778-9014
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO40420174400000X
CAA404202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29119Medicare UPIN
CA00A404200Medicare ID - Type Unspecified