Provider Demographics
NPI:1467652602
Name:SAN DIEGO, ROSITA DE LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSITA
Middle Name:DE LEON
Last Name:SAN DIEGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9148 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2240
Mailing Address - Country:US
Mailing Address - Phone:818-893-9299
Mailing Address - Fax:818-893-9299
Practice Address - Street 1:18631 SHERMAN WAY
Practice Address - Street 2:SUITE F
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4193
Practice Address - Country:US
Practice Address - Phone:818-996-9961
Practice Address - Fax:636-222-9670
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98076208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice