Provider Demographics
NPI:1780009167
Name:DE LEON, ALFREDO REGODON JR
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:REGODON
Last Name:DE LEON
Suffix:JR
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 1:2086 E 13TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3335
Mailing Address - Country:US
Mailing Address - Phone:718-676-0006
Mailing Address - Fax:
Practice Address - Street 1:2086 E 13TH ST
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3335
Practice Address - Country:US
Practice Address - Phone:718-676-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist