Provider Demographics
NPI:1194403154
Name:DE LEON, TRISTAN J (CNIM)
Entity type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:J
Last Name:DE LEON
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 BELLINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7015
Mailing Address - Country:US
Mailing Address - Phone:540-993-2412
Mailing Address - Fax:
Practice Address - Street 1:852 BELLINGHAM WAY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-7015
Practice Address - Country:US
Practice Address - Phone:540-993-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist