Healthcare Provider Details

I. General information

NPI: 1659536928
Provider Name (Legal Business Name): PHILOMENA LEON S.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N LEE TREVINO DR SUITE 406
EL PASO TX
79936-6400
US

IV. Provider business mailing address

4161 E HIGHWAY 290 SUITE 400
DRIPPING SPRINGS TX
78620-4446
US

V. Phone/Fax

Practice location:
  • Phone: 915-591-3336
  • Fax: 915-975-8168
Mailing address:
  • Phone: 512-858-9580
  • Fax: 512-858-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18665
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: