Provider Demographics
NPI:1184335523
Name:DE LEON, ALIYAH GRACE PANGANIBAN (PT)
Entity type:Individual
Prefix:
First Name:ALIYAH GRACE
Middle Name:PANGANIBAN
Last Name:DE LEON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 DAMON ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4229
Mailing Address - Country:US
Mailing Address - Phone:619-635-8259
Mailing Address - Fax:
Practice Address - Street 1:205 GRANADA ST
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7715
Practice Address - Country:US
Practice Address - Phone:805-482-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist