Healthcare Provider Details

I. General information

NPI: 1528309085
Provider Name (Legal Business Name): TANIA BEATRIZ DE LEON CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

4925 CROMWELL DR APT. 8202
KYLE TX
78640-6190
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 956-204-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number60897
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: