Healthcare Provider Details

I. General information

NPI: 1225262587
Provider Name (Legal Business Name): JUAN CARLOS DE LEON LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SUGAR CREEK CENTER BLVD STE 618
SUGAR LAND TX
77478-3540
US

IV. Provider business mailing address

1 SUGAR CREEK CENTER BLVD STE 618
SUGAR LAND TX
77478-3540
US

V. Phone/Fax

Practice location:
  • Phone: 832-655-4141
  • Fax: 713-457-5188
Mailing address:
  • Phone: 832-655-4141
  • Fax: 713-457-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number09-136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: