Provider Demographics
NPI:1245838952
Name:DE LEON, REECE JESUS (RPH)
Entity type:Individual
Prefix:
First Name:REECE JESUS
Middle Name:
Last Name:DE LEON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 MONTEREY HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6149
Mailing Address - Country:US
Mailing Address - Phone:408-378-2363
Mailing Address - Fax:
Practice Address - Street 1:1939 MONTEREY HWY STE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6149
Practice Address - Country:US
Practice Address - Phone:408-378-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist