Individual
MARY DE LEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1619 S ADAMS ST, GLENDALE, CA 91205-3608
(323) 458-3055
Mailing address
1619 S ADAMS ST, GLENDALE, CA 91205-3608
(323) 458-3055
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95020893
CA
363LA2200X
Adult Health Nurse Practitioner
95020893
CA
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
95020893
CA
Other
Enumeration date
04/21/2025
Last updated
07/10/2025
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