Provider Demographics
NPI:1104242650
Name:DELEON, JOSEPH ANDREW (CCP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:DELEON
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6171
Mailing Address - Country:US
Mailing Address - Phone:956-533-0898
Mailing Address - Fax:
Practice Address - Street 1:2321 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6171
Practice Address - Country:US
Practice Address - Phone:956-533-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0283171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor