Provider Demographics
NPI:1174962062
Name:DE LEON, STEPHANIE JORDAN
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JORDAN
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 1:6330 RUGBY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4066
Mailing Address - Country:US
Mailing Address - Phone:323-277-7678
Mailing Address - Fax:323-277-7686
Practice Address - Street 1:6330 RUGBY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4066
Practice Address - Country:US
Practice Address - Phone:323-277-7678
Practice Address - Fax:323-277-7686
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker