Provider Demographics
NPI:1194746230
Name:JEFF P. DELEON, DO., INC.
Entity type:Organization
Organization Name:JEFF P. DELEON, DO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:P
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-444-0737
Mailing Address - Street 1:440 FAIR DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6274
Mailing Address - Country:US
Mailing Address - Phone:714-444-0737
Mailing Address - Fax:714-444-0742
Practice Address - Street 1:440 FAIR DR
Practice Address - Street 2:SUITE E
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6274
Practice Address - Country:US
Practice Address - Phone:714-444-0737
Practice Address - Fax:714-444-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX72790Medicaid
CA00AX72790Medicaid
W17318Medicare PIN