Provider Information for 1740826874
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BRANDI DIAZ DELEON LPC
Sex: Female
NPI: 1740826874
Last Updated: 2024-11-04
Certification Date: 2024-11-04
Certification Date: 2024-11-04
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740826874 | ||||||||
| Enumeration Date | 2019-11-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 1326 MARSHALL, TX 75671-1326 United States Phone: 903-927-3782 | Fax:903-927-1764 | ||||||||
| Primary Practice Address | 4077 JEFFERSON AVE TEXARKANA, AR 71854-1509 United States Phone: 870-330-9200 | Fax: | ||||||||
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