Provider Demographics
NPI:1538820113
Name:DE LEON, EDWARD MICHAEL (DC, ATC, CMT)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:DE LEON
Suffix:
Gender:M
Credentials:DC, ATC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 HARVESTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2704
Mailing Address - Country:US
Mailing Address - Phone:408-677-7518
Mailing Address - Fax:
Practice Address - Street 1:3033 HARVESTWOOD CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2704
Practice Address - Country:US
Practice Address - Phone:408-677-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000307202255A2300X
CA42341225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer