Provider Demographics
NPI:1689111692
Name:DE LEON, MAYRA A
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:A
Last Name:DE LEON
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 1:611 W EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-8842
Mailing Address - Country:US
Mailing Address - Phone:956-223-9118
Mailing Address - Fax:
Practice Address - Street 1:611 W EAGLE AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-8842
Practice Address - Country:US
Practice Address - Phone:956-223-9118
Practice Address - Fax:833-860-7214
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No253Z00000XAgenciesIn Home Supportive Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child