Provider Demographics
NPI:1790080299
Name:LEONCIO, JOVELYN ATIJERA (PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:JOVELYN
Middle Name:ATIJERA
Last Name:LEONCIO
Suffix:
Gender:F
Credentials:PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 SILLANO DR
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-9107
Mailing Address - Country:US
Mailing Address - Phone:661-721-2065
Mailing Address - Fax:
Practice Address - Street 1:1325 5TH AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3633
Practice Address - Country:US
Practice Address - Phone:661-721-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0100X
CAP4596385103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service