Provider Demographics
NPI:1871023275
Name:CONRADO DELEON MD
Entity Type:Organization
Organization Name:CONRADO DELEON MD
Other - Org Name:CONRADO DELEON MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-592-9921
Mailing Address - Street 1:403 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1822
Mailing Address - Country:US
Mailing Address - Phone:509-592-9921
Mailing Address - Fax:509-329-6141
Practice Address - Street 1:403 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1822
Practice Address - Country:US
Practice Address - Phone:509-592-9921
Practice Address - Fax:509-329-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024096207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010091Medicaid