Provider Demographics
NPI:1285775437
Name:DE LEON, MARIA LOURDES CASTANOS (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA LOURDES
Middle Name:CASTANOS
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2933 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1528
Mailing Address - Country:US
Mailing Address - Phone:323-263-2669
Mailing Address - Fax:323-263-2673
Practice Address - Street 1:9916 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6108
Practice Address - Country:US
Practice Address - Phone:323-564-1100
Practice Address - Fax:323-564-1133
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73468208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A734680Medicare UPIN