Healthcare Provider Details

I. General information

NPI: 1255014643
Provider Name (Legal Business Name): CHANEL M DELEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24124 CINCO VILLAGE CENTER BLVD STE 200
KATY TX
77494-8389
US

IV. Provider business mailing address

24124 CINCO VILLAGE CENTER BLVD STE 200
KATY TX
77494-8389
US

V. Phone/Fax

Practice location:
  • Phone: 760-906-1304
  • Fax:
Mailing address:
  • Phone: 760-906-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: