Provider Demographics
NPI:1831871599
Name:DE LEON, PAUL JOHN (FNC, FNLP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:DE LEON
Suffix:
Gender:M
Credentials:FNC, FNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RIVERCREST LN
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4258
Mailing Address - Country:US
Mailing Address - Phone:763-273-6135
Mailing Address - Fax:
Practice Address - Street 1:5 RIVERCREST LN
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4258
Practice Address - Country:US
Practice Address - Phone:763-273-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist