Provider Demographics
NPI:1831358548
Name:DE LEON, JOSE ROY C (RPT)
Entity type:Individual
Prefix:MR
First Name:JOSE ROY
Middle Name:C
Last Name:DE LEON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 TOLAND WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3615
Mailing Address - Country:US
Mailing Address - Phone:213-400-1640
Mailing Address - Fax:
Practice Address - Street 1:3740 TOLAND WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3615
Practice Address - Country:US
Practice Address - Phone:213-400-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist