Provider Demographics
NPI:1508282708
Name:COBOS, LETICIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:COBOS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 S CAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5458
Mailing Address - Country:US
Mailing Address - Phone:956-475-3031
Mailing Address - Fax:956-475-3680
Practice Address - Street 1:524 S CAGE BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5458
Practice Address - Country:US
Practice Address - Phone:956-475-3031
Practice Address - Fax:956-475-3680
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant