Provider Demographics
NPI:1851271456
Name:DE LEON, MARICEL P
Entity type:Individual
Prefix:
First Name:MARICEL
Middle Name:P
Last Name:DE LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 W LULLABY LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6008
Mailing Address - Country:US
Mailing Address - Phone:714-517-0916
Mailing Address - Fax:657-201-3619
Practice Address - Street 1:1955 W LULLABY LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6008
Practice Address - Country:US
Practice Address - Phone:714-517-0916
Practice Address - Fax:657-201-3619
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306000607251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health