Provider Demographics
NPI:1457996506
Name:DELEON-ROBLERO, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:DELEON-ROBLERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19785 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:DE
Mailing Address - Zip Code:19960-2665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19785 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:DE
Practice Address - Zip Code:19960-2665
Practice Address - Country:US
Practice Address - Phone:302-259-5697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer