Provider Demographics
NPI:1932635489
Name:MAYRA A DE LEON
Entity Type:Organization
Organization Name:MAYRA A DE LEON
Other - Org Name:DE LEON CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-223-9118
Mailing Address - Street 1:611 W EAGLE AVE
Mailing Address - Street 2:611 W EAGLE AVE
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-8842
Mailing Address - Country:US
Mailing Address - Phone:956-720-1027
Mailing Address - Fax:
Practice Address - Street 1:611 W EAGLE AVE
Practice Address - Street 2:611 W EAGLE AVE
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-8842
Practice Address - Country:US
Practice Address - Phone:956-720-1027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001029709Medicaid