Provider Demographics
NPI:1134672579
Name:DE LEON, GILBERT (SA-C)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:DE LEON
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-3619
Mailing Address - Country:US
Mailing Address - Phone:956-843-2094
Mailing Address - Fax:
Practice Address - Street 1:415 S 29TH ST
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:TX
Practice Address - Zip Code:78557-3619
Practice Address - Country:US
Practice Address - Phone:956-843-2094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-457246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant