Provider Demographics
NPI:1275995193
Name:PELICANO-GOERS, LEYRA TERESA (DNP, AGPCNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:LEYRA
Middle Name:TERESA
Last Name:PELICANO-GOERS
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Gender:F
Credentials:DNP, AGPCNP-BC, RN
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Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-773-9750
Mailing Address - Fax:760-773-9294
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-773-9750
Practice Address - Fax:760-773-9294
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA2004045363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health