Provider Demographics
NPI:1699443580
Name:DE LEON-GARCIA, GUALBERTO L (RD, LD)
Entity type:Individual
Prefix:
First Name:GUALBERTO
Middle Name:L
Last Name:DE LEON-GARCIA
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NORTHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2635
Mailing Address - Country:US
Mailing Address - Phone:210-748-9827
Mailing Address - Fax:
Practice Address - Street 1:111 NORTHILL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2635
Practice Address - Country:US
Practice Address - Phone:210-748-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered