| De Leon Medical Clinic Inc | |
|
1520 Liliha St Ste 203 Honolulu HI 96817-3563 | |
| (808) 528-3571 | |
| (808) 528-0196 |
| Full Name | De Leon Medical Clinic Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1520 Liliha St Ste 203, Honolulu, Hawaii |
| Authorized Official Name and Position | Jose C De Leon (PRESIDENT) |
| Authorized Official Contact | 8085283571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| De Leon Medical Clinic Inc 1520 Liliha St Ste 203 Honolulu HI 96817-3563 Ph: (808) 528-3571 | De Leon Medical Clinic Inc 1520 Liliha St Ste 203 Honolulu HI 96817-3563 Ph: (808) 528-3571 |
| NPI Number | 1104258870 |
|---|---|
| Provider Enumeration Date | 08/05/2013 |
| Last Update Date | 08/05/2013 |
| Medicare PECOS PAC ID | 5991947020 |
|---|---|
| Medicare Enrollment ID | O20130820000192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104258870 | NPI | - | NPPES |
| MD-3031 | Other | HAWAII LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD-3031 (Hawaii) | Primary |
| Provider Name | Jose C De Leon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275639866 PECOS PAC ID: 3870519036 Enrollment ID: I20051018000569 |
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