Provider Demographics
NPI:1083886303
Name:GRACIELA M LEIJA MD PA
Entity Type:Organization
Organization Name:GRACIELA M LEIJA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEIJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-504-4800
Mailing Address - Street 1:95 E. PRICE RD.
Mailing Address - Street 2:STE. E
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3565
Mailing Address - Country:US
Mailing Address - Phone:956-504-4800
Mailing Address - Fax:956-584-4801
Practice Address - Street 1:95 E. PRICE RD.
Practice Address - Street 2:STE. E
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3565
Practice Address - Country:US
Practice Address - Phone:956-504-4800
Practice Address - Fax:956-504-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1083322OtherCLIA CERTIFICATE
TX45D1083322OtherCLIA CERTIFICATE