Provider Demographics
NPI:1528750981
Name:SARA M. DELEON, PSYD CORP
Entity type:Organization
Organization Name:SARA M. DELEON, PSYD CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:951-223-1117
Mailing Address - Street 1:41690 ENTERPRISE CIR N STE 110
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5658
Mailing Address - Country:US
Mailing Address - Phone:951-223-1117
Mailing Address - Fax:951-290-3621
Practice Address - Street 1:41690 ENTERPRISE CIR N STE 110
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5658
Practice Address - Country:US
Practice Address - Phone:951-223-1117
Practice Address - Fax:951-290-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities