Provider Demographics
NPI:1073378303
Name:MURILLO IGLESIAS, LESLY MARGARITA
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:MARGARITA
Last Name:MURILLO IGLESIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 MOUNT PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2242
Mailing Address - Country:US
Mailing Address - Phone:571-393-4052
Mailing Address - Fax:
Practice Address - Street 1:14201 MOUNT PLEASANT DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2242
Practice Address - Country:US
Practice Address - Phone:571-393-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189495363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health