Provider Demographics
NPI:1629817598
Name:DE LA PAZ CEBALLOS, LEGNA LETICIA (SA-C)
Entity type:Individual
Prefix:
First Name:LEGNA
Middle Name:LETICIA
Last Name:DE LA PAZ CEBALLOS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18014 MOUNTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2396
Mailing Address - Country:US
Mailing Address - Phone:786-710-5421
Mailing Address - Fax:
Practice Address - Street 1:18014 MOUNTFIELD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2396
Practice Address - Country:US
Practice Address - Phone:786-710-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22-738246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant