Provider Demographics
NPI:1881656031
Name:DE LEON, NICERIO RAZON (DC, NP-C)
Entity Type:Individual
Prefix:DR
First Name:NICERIO
Middle Name:RAZON
Last Name:DE LEON
Suffix:
Gender:M
Credentials:DC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1605 ROCK PRAIRIE RD
Mailing Address - Street 2:315
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8358
Mailing Address - Country:US
Mailing Address - Phone:979-694-2026
Mailing Address - Fax:979-694-6403
Practice Address - Street 1:1605 ROCK PRAIRIE RD
Practice Address - Street 2:315
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8358
Practice Address - Country:US
Practice Address - Phone:979-694-2026
Practice Address - Fax:979-694-6403
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6661111N00000X
TX774921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088475102Medicaid
TXU57258Medicare UPIN
TXTXB140619Medicare PIN