Provider Demographics
NPI:1932701729
Name:DELEON, CAROLINA (LO)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:DELEON
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HAWLEY LN STE 107
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5379
Mailing Address - Country:US
Mailing Address - Phone:203-385-5705
Mailing Address - Fax:
Practice Address - Street 1:160 HAWLEY LN STE 107
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5379
Practice Address - Country:US
Practice Address - Phone:203-385-5705
Practice Address - Fax:203-378-2968
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001805156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician