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Kristofer Andrew F De Leon

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

757 Westwood Plz, Los Angeles, CA 90095-6215

PECOS Enrollment

This provider is enrolled in PECOS as KRISTOFER ANDREW DE LEON.

Based on the most recent information from CMS, provider Kristofer Andrew F De Leon is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:00 PM.

Profile Details

Provider ID
1447985395
Provider Type
Individual
Full Name
De Leon, Kristofer Andrew F
Credential
AGACNP

Gender
Male
Sole Proprietor
No
Enumeration Date
7/22/2022
Last Updated
2/3/2023

Contact Information

Practice Location

757 Westwood Plz, Los Angeles, CA 90095-6215

(310) 825-7912

(310) 267-1899

Mailing Location

5767 W Century Blvd Ste 400, Los Angeles, CA 90045-5631

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LA2100X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 95021669 California

Kristofer Andrew F De Leon

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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