Provider Demographics
NPI:1003024944
Name:DE LEON, JOSE L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:DE LEON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:913 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5807
Mailing Address - Country:US
Mailing Address - Phone:830-775-2234
Mailing Address - Fax:830-775-7325
Practice Address - Street 1:913 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5807
Practice Address - Country:US
Practice Address - Phone:830-775-2234
Practice Address - Fax:830-775-7325
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant