Provider Demographics
NPI:1154887347
Name:LEON, DIANA T (DC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:T
Last Name:LEON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 E CASTRO VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-4840
Mailing Address - Country:US
Mailing Address - Phone:510-247-1272
Mailing Address - Fax:510-881-1334
Practice Address - Street 1:4035 E CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-4840
Practice Address - Country:US
Practice Address - Phone:510-247-1272
Practice Address - Fax:510-881-1334
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34167OtherCHIROPRACTIC LICENSE