Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 95010593 | CA |
NPI | 1003478637 |
---|---|
Provider Name | Melissa Ann De Leon |
First Address | San Jose, CA 95110-2817 |
Second Address | San Jose, CA 95110-2817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 03/07/2019 |