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General NPI Number Information
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NPI Number | 1609104066
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Entity Type | Individual
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Provider Name | MARY OLIVIA DE LEON F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 4920 N. EXPRESSWAY, ALTON GLOOR PLAZA#101
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City | BROWNSVILLE
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State | TX
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Zip | 78526
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Country | US
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Telephone | 956-350-5530
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Fax | 956-350-5527
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Provider Business Mailing Address
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Address Line | 1474 W. PRICE RD STE 7 BOX 536
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City | BROWNSVILLE
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State | TX
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Zip | 78520-8675
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Country | US
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Telephone | 956-350-5530
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Fax | 956-350-5527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | 670508
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License Number State | TX
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