Individual
NICKOLAS PAUL DE LEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
344 E 6TH ST, MADERA, CA 93638-3631
(559) 664-4000
(559) 675-5224
Mailing address
344 E 6TH ST, MADERA, CA 93638-3631
(559) 664-4000
(559) 675-5224
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
58866
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/19/2019
Last updated
11/29/2021
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