Provider Demographics
NPI:1417766403
Name:JUAN JOSE DE LEON DIAZ
Entity type:Organization
Organization Name:JUAN JOSE DE LEON DIAZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERPRETER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:DE LEON DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-264-2212
Mailing Address - Street 1:1881 CAMPUS COMMONS DRIVE, SUITE 500
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1881 CAMPUS COMMONS DRIVE, SUITE 500
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:857-264-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty