Healthcare Provider Details

I. General information

NPI: 1427538768
Provider Name (Legal Business Name): JANELLE EVETH DE LEON LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 N MCCOLL RD
MCALLEN TX
78504-2208
US

IV. Provider business mailing address

2017 GLENDALE DR
EDINBURG TX
78541-1526
US

V. Phone/Fax

Practice location:
  • Phone: 956-972-1920
  • Fax: 956-972-0339
Mailing address:
  • Phone: 956-376-8095
  • Fax: 956-972-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number228978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: