Provider Demographics
NPI:1689045619
Name:DE LEON, EUGENIO SILVERIO III
Entity Type:Individual
Prefix:MR
First Name:EUGENIO
Middle Name:SILVERIO
Last Name:DE LEON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 N LANDFAIR ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-1109
Mailing Address - Country:US
Mailing Address - Phone:619-245-5614
Mailing Address - Fax:
Practice Address - Street 1:1731 N LANDFAIR ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-1109
Practice Address - Country:US
Practice Address - Phone:619-245-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA817571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse