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Sarah Elizabeth Diaz De Leon

Family Medicine

Allopathic & Osteopathic Physicians

1500 S Main St Fl 4, Fort Worth, TX 76104-4917

PECOS Enrollment

This provider is enrolled in PECOS as SARAH DIAZ DE LEON.

Based on the most recent information from CMS, provider Sarah Elizabeth Diaz De Leon is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1275854093
Provider Type
Individual
Full Name
Diaz De Leon, Sarah Elizabeth
Credential
M.D.

Gender
Female
Sole Proprietor
Yes
Enumeration Date
6/16/2010
Last Updated
12/13/2018

Contact Information

Practice Location

1500 S Main St Fl 4, Fort Worth, TX 76104-4917

(817) 702-1215

(817) 702-6843

Mailing Location

PO Box 732973, Dallas, TX 75373-2973

(817) 702-8450

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License P4042 Texas
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License BP10037206 Texas

Sarah Elizabeth Diaz De Leon

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

Code

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