Provider Demographics
NPI:1245579648
Name:LEON, MARIA LILIAN (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LILIAN
Last Name:LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 INTERSTATE 30 STE 100
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2662
Mailing Address - Country:US
Mailing Address - Phone:972-682-1791
Mailing Address - Fax:972-698-7641
Practice Address - Street 1:5315 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7418
Practice Address - Country:US
Practice Address - Phone:214-826-2151
Practice Address - Fax:214-826-2196
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4175208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010562155Medicaid