Provider Demographics
NPI:1811423064
Name:DEZA LEON, MARIA PAZ (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:PAZ
Last Name:DEZA LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 GOLFVIEW DR APT 103
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3816
Mailing Address - Country:US
Mailing Address - Phone:667-216-9567
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN BOULEVARD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2018-01-18
Deactivation Date:2017-12-13
Deactivation Code:
Reactivation Date:2018-01-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301113285390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program