Provider Demographics
NPI:1952836744
Name:EDWIN ROMEL S. DE LEON, M.D., INC.
Entity Type:Organization
Organization Name:EDWIN ROMEL S. DE LEON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN ROMEL
Authorized Official - Middle Name:SORIANO
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-992-5853
Mailing Address - Street 1:208 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4018
Mailing Address - Country:US
Mailing Address - Phone:909-886-3100
Mailing Address - Fax:
Practice Address - Street 1:208 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4018
Practice Address - Country:US
Practice Address - Phone:909-886-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1185302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty