Provider Demographics
NPI:1225262587
Name:DE LEON, JUAN CARLOS (LSA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
Last Name:DE LEON
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3540
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09-136246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8LV100OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX8LV183OtherBCBC - UNIVERSAL SURGICAL PARTNERS
TX8PX982OtherBCBS - US MSO
TXSA00728OtherTEXAS MEDICAL BOARD
TX8LH890OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX8LV409OtherXCITE SURGICAL LLC