Provider Demographics
NPI:1669998803
Name:DELEON, MARCOS A (MA-SLP)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:A
Last Name:DELEON
Suffix:
Gender:M
Credentials:MA-SLP
Other - Prefix:
Other - First Name:MARCOS
Other - Middle Name:A
Other - Last Name:DELEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1741 CHISOLM TRL
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-1862
Mailing Address - Country:US
Mailing Address - Phone:361-945-2954
Mailing Address - Fax:
Practice Address - Street 1:1741 CHISOLM TRL
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-1862
Practice Address - Country:US
Practice Address - Phone:361-945-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist