Provider Demographics
NPI:1437705852
Name:PILAR, LETICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:PILAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 S DENTON TAP RD STE 123
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4099
Mailing Address - Country:US
Mailing Address - Phone:724-620-7629
Mailing Address - Fax:
Practice Address - Street 1:580 S DENTON TAP RD STE 123
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4099
Practice Address - Country:US
Practice Address - Phone:972-462-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant