Provider Demographics
NPI:1952077216
Name:DE LEON, SERENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SERENE
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13178 ALTA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3461
Mailing Address - Country:US
Mailing Address - Phone:818-322-8951
Mailing Address - Fax:
Practice Address - Street 1:13178 ALTA VISTA WAY
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3461
Practice Address - Country:US
Practice Address - Phone:818-322-8951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily