Provider Demographics
NPI:1356913701
Name:DEAN, LETICIA INEZ (CPT)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:INEZ
Last Name:DEAN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8503
Mailing Address - Country:US
Mailing Address - Phone:409-338-2354
Mailing Address - Fax:
Practice Address - Street 1:7595 WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-8503
Practice Address - Country:US
Practice Address - Phone:409-338-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT9N6K9N8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy