Provider Demographics
NPI:1255433132
Name:DELEON, FELINO BAUTISTA III (MD)
Entity type:Individual
Prefix:DR
First Name:FELINO
Middle Name:BAUTISTA
Last Name:DELEON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3716 PACIFIC AVE
Mailing Address - Street 2:SUITE #D
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418
Mailing Address - Country:US
Mailing Address - Phone:253-474-7719
Mailing Address - Fax:253-471-8592
Practice Address - Street 1:3716 PACIFIC AVE
Practice Address - Street 2:SUITE #D
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418
Practice Address - Country:US
Practice Address - Phone:253-474-7719
Practice Address - Fax:253-471-8592
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00022250208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1022730Medicaid
E17342Medicare UPIN