Provider Demographics
NPI:1982255857
Name:DELEON, EVETTE MARIE
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:MARIE
Last Name:DELEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77800 MICHIGAN DR APT K577800
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6004
Mailing Address - Country:US
Mailing Address - Phone:760-702-5963
Mailing Address - Fax:
Practice Address - Street 1:77800 MICHIGAN DR APT K577800
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6004
Practice Address - Country:US
Practice Address - Phone:760-702-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty