Provider Demographics
NPI:1508075482
Name:RECTO F. DELEON, M.D. INC.
Entity Type:Organization
Organization Name:RECTO F. DELEON, M.D. INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RECTO
Authorized Official - Middle Name:FERNANDEZ
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-527-7677
Mailing Address - Street 1:1130 COFFEE RD
Mailing Address - Street 2:STE 9B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4228
Mailing Address - Country:US
Mailing Address - Phone:209-527-7677
Mailing Address - Fax:209-527-2306
Practice Address - Street 1:1130 COFFEE RD
Practice Address - Street 2:STE 9B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4228
Practice Address - Country:US
Practice Address - Phone:209-527-7677
Practice Address - Fax:209-527-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty