Provider Demographics
NPI:1891819090
Name:DE LEON, BALDOMERO JR (MD)
Entity Type:Individual
Prefix:
First Name:BALDOMERO
Middle Name:
Last Name:DE LEON
Suffix:JR
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1479 YNACIO VALLEY ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-932-1018
Mailing Address - Fax:925-932-7938
Practice Address - Street 1:1479 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE #201
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2986
Practice Address - Country:US
Practice Address - Phone:925-932-1018
Practice Address - Fax:925-932-7938
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG35749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46466Medicare UPIN