Provider Demographics
NPI:1619420064
Name:DE LEON FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:DE LEON FAMILY PRACTICE PLLC
Other - Org Name:DE LEON FAMILY PRACTICE PA-C
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN ASSISTANT - CERTIFIED
Authorized Official - Prefix:MS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:830-352-4196
Mailing Address - Street 1:821 WAGON WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-2456
Mailing Address - Country:US
Mailing Address - Phone:830-352-4196
Mailing Address - Fax:
Practice Address - Street 1:1975 N VETERANS BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6114
Practice Address - Country:US
Practice Address - Phone:830-758-1633
Practice Address - Fax:830-773-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03199261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care