Provider Demographics
NPI:1801559430
Name:LEON, ISABELLA DEOMAMPO (CNA)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:DEOMAMPO
Last Name:LEON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 CALLISTO TER
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2780
Mailing Address - Country:US
Mailing Address - Phone:619-361-4610
Mailing Address - Fax:
Practice Address - Street 1:2056 CALLISTO TER
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2780
Practice Address - Country:US
Practice Address - Phone:619-361-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01206703376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide