Provider Demographics
NPI:1174168579
Name:DELEON, DIANE MICHELLE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MICHELLE
Last Name:DELEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MISSION CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-4764
Mailing Address - Country:US
Mailing Address - Phone:210-872-4151
Mailing Address - Fax:
Practice Address - Street 1:9614 ELMSTONE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6724
Practice Address - Country:US
Practice Address - Phone:210-748-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider