Provider Demographics
NPI:1124912779
Name:DE LEON, ERIK (CMP)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:DE LEON
Suffix:
Gender:M
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 SAN PABLO AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2073
Mailing Address - Country:US
Mailing Address - Phone:650-888-3039
Mailing Address - Fax:
Practice Address - Street 1:2521 SAN PABLO AVE APT C
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2073
Practice Address - Country:US
Practice Address - Phone:650-888-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26471225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist