Provider Demographics
NPI:1275357097
Name:DE LEON, JAMIE ROSE TANCIATCO
Entity type:Individual
Prefix:
First Name:JAMIE ROSE
Middle Name:TANCIATCO
Last Name:DE LEON
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 1:784 VADA ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6456
Mailing Address - Country:US
Mailing Address - Phone:619-991-4005
Mailing Address - Fax:
Practice Address - Street 1:2835 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7404
Practice Address - Country:US
Practice Address - Phone:209-683-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37028124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist