Provider Demographics
NPI:1063177061
Name:LEON ESCALONA, CARLOS ELEAZAR
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ELEAZAR
Last Name:LEON ESCALONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 EXCELLENCE WAY APT 2064
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-1228
Mailing Address - Country:US
Mailing Address - Phone:469-504-8137
Mailing Address - Fax:
Practice Address - Street 1:6501 EXCELLENCE WAY APT 2064
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-1228
Practice Address - Country:US
Practice Address - Phone:469-504-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health