Provider Demographics
NPI:1902387681
Name:DE LEON, GRISELDA (COTA)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12446 PASEO BLANCO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5681
Mailing Address - Country:US
Mailing Address - Phone:915-588-5292
Mailing Address - Fax:
Practice Address - Street 1:10064 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-1801
Practice Address - Country:US
Practice Address - Phone:915-773-0744
Practice Address - Fax:915-790-0612
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212084224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant