Provider Demographics
NPI:1265191167
Name:LEON, ESMERALDA (SOME COLLEGE)
Entity type:Individual
Prefix:MISS
First Name:ESMERALDA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:SOME COLLEGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31777 AVENIDA LA PALOMA
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5253
Mailing Address - Country:US
Mailing Address - Phone:714-262-7337
Mailing Address - Fax:
Practice Address - Street 1:31777 AVENIDA LA PALOMA
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5253
Practice Address - Country:US
Practice Address - Phone:714-262-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty