Provider Demographics
NPI:1588111587
Name:LEON, STEPHEN ORLANDO
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ORLANDO
Last Name:LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 EL CAMINO AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1784
Mailing Address - Country:US
Mailing Address - Phone:951-735-3553
Mailing Address - Fax:951-735-3558
Practice Address - Street 1:1150 EL CAMINO AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1784
Practice Address - Country:US
Practice Address - Phone:951-735-3553
Practice Address - Fax:951-735-3558
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner