Provider Demographics
NPI:1528309085
Name:DE LEON, TANIA BEATRIZ (CTRS)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:BEATRIZ
Last Name:DE LEON
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 CROMWELL DR
Mailing Address - Street 2:APT. 8202
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6190
Mailing Address - Country:US
Mailing Address - Phone:956-204-4717
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60897225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist