Provider Demographics
NPI:1912282062
Name:DELEON, JOSEPH (NCBTMB, OMT, CMRMP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DELEON
Suffix:
Gender:M
Credentials:NCBTMB, OMT, CMRMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13216 MAPLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6105
Mailing Address - Country:US
Mailing Address - Phone:571-839-2866
Mailing Address - Fax:
Practice Address - Street 1:13216 MAPLE CREEK LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-6105
Practice Address - Country:US
Practice Address - Phone:571-839-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019003618171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor