Provider Demographics
NPI:1346872744
Name:LLAMAS, LEONARDO P
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:P
Last Name:LLAMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 MCNUTT RD STE C
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9566
Mailing Address - Country:US
Mailing Address - Phone:512-906-9119
Mailing Address - Fax:
Practice Address - Street 1:2327 MCNUTT RD STE C
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9566
Practice Address - Country:US
Practice Address - Phone:512-906-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor