Provider Demographics
NPI:1922895861
Name:LEON, DESTINY GUADALUPE
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:GUADALUPE
Last Name: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 1:106 LITTLETON ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY PARK
Mailing Address - State:NC
Mailing Address - Zip Code:28544-1712
Mailing Address - Country:US
Mailing Address - Phone:279-210-2695
Mailing Address - Fax:
Practice Address - Street 1:106 LITTLETON ST
Practice Address - Street 2:
Practice Address - City:MIDWAY PARK
Practice Address - State:NC
Practice Address - Zip Code:28544-1712
Practice Address - Country:US
Practice Address - Phone:279-210-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84112225700000X
NC22572225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist