Provider Demographics
NPI:1740901230
Name:DEVAUGHN, DELEON (LPT)
Entity type:Individual
Prefix:MR
First Name:DELEON
Middle Name:
Last Name:DEVAUGHN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-2614
Mailing Address - Country:US
Mailing Address - Phone:626-644-5665
Mailing Address - Fax:
Practice Address - Street 1:232 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2614
Practice Address - Country:US
Practice Address - Phone:626-644-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41083167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician