Healthcare Provider Details

I. General information

NPI: 1124726617
Provider Name (Legal Business Name): IVONNE GARCIA-DELEON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BLALOCK RD STE M
HOUSTON TX
77080-5446
US

IV. Provider business mailing address

15306 PALTON SPRINGS DR
HOUSTON TX
77082-3018
US

V. Phone/Fax

Practice location:
  • Phone: 832-831-4883
  • Fax:
Mailing address:
  • Phone: 713-820-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1111353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: