Provider Demographics
NPI:1407508831
Name:ALVARADO, LEANDRA RYAN (LSA)
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:RYAN
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-2518
Mailing Address - Country:US
Mailing Address - Phone:361-222-2144
Mailing Address - Fax:
Practice Address - Street 1:449 E ELM ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-2518
Practice Address - Country:US
Practice Address - Phone:361-222-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty