Provider Demographics
NPI:1851688634
Name:DELEON, SARA C (BA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:DELEON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 LEEWARD LN
Mailing Address - Street 2:APT 617
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-2573
Mailing Address - Country:US
Mailing Address - Phone:817-253-8386
Mailing Address - Fax:
Practice Address - Street 1:4620 LEEWARD LN
Practice Address - Street 2:APT 617
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2573
Practice Address - Country:US
Practice Address - Phone:817-253-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist