Provider Demographics
NPI:1912461948
Name:DELEON, ANTOINETTE (DACM, LAC, DIPLOM)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:DELEON
Suffix:
Gender:F
Credentials:DACM, LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 CAMINO DEL ARROYO STE 129
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4100
Mailing Address - Country:US
Mailing Address - Phone:858-859-1959
Mailing Address - Fax:
Practice Address - Street 1:5080 CAMINO DEL ARROYO STE 129
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3153
Practice Address - Country:US
Practice Address - Phone:858-859-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18145171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist