| Ms Mia De Leon, NP | |
| 
					960 S Westlake Blvd Ste 208, Westlake Village, CA 91361-3162  | |
| (805) 379-5970 | |
| (805) 379-5211 | 
| Full Name | Ms Mia De Leon | 
|---|---|
| Gender | Female | 
| Speciality | Nurse Practitioner | 
| Location | 960 S Westlake Blvd Ste 208, Westlake Village, California | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1700119195 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 363L00000X | Nurse Practitioner | CA497626 (California) | Primary | 
| 207NS0135X | Dermatology - Procedural Dermatology | NP9810 (California) | Secondary | 
| Entity Name | Proderm Image A Professional Medical Corporation | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1811667264 PECOS PAC ID: 1355883042 Enrollment ID: O20240610002404  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Ms Mia De Leon, NP 960 S Westlake Blvd Ste 208, Westlake Village, CA 91361-3162 Ph: (805) 379-5970  | Ms Mia De Leon, NP 960 S Westlake Blvd Ste 208, Westlake Village, CA 91361-3162 Ph: (805) 379-5970  | 
Mrs. Jennifer Salerno, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 860 Hampshire Rd Ste I, Westlake Village, CA 91361 Phone: 805-358-1222  | |
Marichu Quizon Cortes, RN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 125 Auburn Ct Ste 220, Westlake Village, CA 91362 Phone: 805-360-5205  | |
Linda Ann Woody-godsave, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1250 La Venta Dr Ste 112, Westlake Village, CA 91361 Phone: 805-496-5153 Fax: 805-496-5202  | |
Denise Marie Carlton, MSN, WHNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1220 La Venta Dr, Suite 209, Westlake Village, CA 91361 Phone: 805-497-9119 Fax: 805-497-4199  | |
Daria M. Schneidman-fernandez, N.P. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 32144 Agoura Rd, Suite 218, Westlake Village, CA 91361 Phone: 818-889-9230 Fax: 818-889-9231  | |
Ethel Antonio, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 31194 La Baya Dr, Westlake Village, CA 91362 Phone: 805-341-3416  | |
Mary Hanna, NP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 32144 Agoura Rd Ste 112, Westlake Village, CA 91361 Phone: 818-208-1264  |