Provider Demographics
NPI:1497594154
Name:DE LEON, MATTHEW ISAIAH
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ISAIAH
Last Name:DE LEON
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 1:1820 S CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4417
Mailing Address - Country:US
Mailing Address - Phone:559-772-8144
Mailing Address - Fax:
Practice Address - Street 1:1820 S CENTRAL ST STE C
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4420
Practice Address - Country:US
Practice Address - Phone:559-772-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty