Provider Demographics
NPI:1396350716
Name:DE LEON, STEPHANIE MARIE ONG (A-GNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE ONG
Last Name:DE LEON
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4220
Mailing Address - Country:US
Mailing Address - Phone:510-986-6800
Mailing Address - Fax:
Practice Address - Street 1:250 E 18TH ST FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1716
Practice Address - Country:US
Practice Address - Phone:510-735-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95222645163W00000X
CAAG07200182363LA2200X
CA95016216363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health