Provider Demographics
NPI:1538618707
Name:DE LEON, JOCELYN GUAN (RDN)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:GUAN
Last Name:DE LEON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4787 CLYDELLE AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4787 CLYDELLE AVE
Practice Address - Street 2:APT. 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4211
Practice Address - Country:US
Practice Address - Phone:408-887-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86041378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered