Provider Demographics
NPI:1386941227
Name:DIAZDELEON, PRISCILLA DIANE (MA)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:DIANE
Last Name:DIAZDELEON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12019 INDIGO BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2905
Mailing Address - Country:US
Mailing Address - Phone:949-606-2818
Mailing Address - Fax:
Practice Address - Street 1:12019 INDIGO BND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2905
Practice Address - Country:US
Practice Address - Phone:949-606-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105707235Z00000X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist