Provider Demographics
NPI:1760407621
Name:J & L DE LEON MEDICAL CORPORATION
Entity Type:Organization
Organization Name:J & L DE LEON MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:MATA
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-633-5438
Mailing Address - Street 1:16660 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE # 211
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5433
Mailing Address - Country:US
Mailing Address - Phone:562-633-5438
Mailing Address - Fax:562-633-1685
Practice Address - Street 1:16660 PARAMOUNT BLVD
Practice Address - Street 2:SUITE # 211
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5433
Practice Address - Country:US
Practice Address - Phone:562-633-5438
Practice Address - Fax:562-633-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099220Medicaid
=========OtherTAX IDENTIFICATION NO.
CAGR0099220Medicaid