Provider Demographics
NPI:1891150876
Name:DE LEON, BENJAMIN JOSEPH
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:DE LEON
Suffix:
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 1:511 W COLLEGE BLVD
Mailing Address - Street 2:A-8
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5135
Mailing Address - Country:US
Mailing Address - Phone:361-290-3686
Mailing Address - Fax:
Practice Address - Street 1:511 W COLLEGE BLVD
Practice Address - Street 2:A-8
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5135
Practice Address - Country:US
Practice Address - Phone:361-290-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist