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General NPI Number Information
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NPI Number | 1619420064
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Entity Type | Organization
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Legal Business Name | DE LEON FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 1975 N VETERANS BLVD SUITE 6
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City | EAGLE PASS
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State | TX
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Zip | 78852-6114
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Country | US
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Telephone | 830-758-1633
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Fax | 830-773-6989
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Provider Business Mailing Address
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Address Line | 821 WAGON WHEEL RD
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City | EAGLE PASS
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State | TX
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Zip | 78852-2456
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Country | US
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Telephone | 830-352-4196
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT - CERTIFIED
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Name | MS. HILDA DE LEON
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Credential | PA-C
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Telephone | 830-352-4196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PA03199
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License Number State | TX
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