Healthcare Provider Details

I. General information

NPI: 1205533825
Provider Name (Legal Business Name): LIEZL ARALAR DE LEON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIEZL DE LEON ELLIOTT RN

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6723 BISCAY HBR
SAN ANTONIO TX
78249-2575
US

IV. Provider business mailing address

6723 BISCAY HBR
SAN ANTONIO TX
78249-2575
US

V. Phone/Fax

Practice location:
  • Phone: 210-254-4089
  • Fax:
Mailing address:
  • Phone: 210-254-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number787248
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: