Provider Demographics
NPI:1518293331
Name:AMADOR, LETICIA ISABEL (P A)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:ISABEL
Last Name:AMADOR
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:DEL RIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26781 PORTOLA PKWY STE 4E
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1758
Mailing Address - Country:US
Mailing Address - Phone:949-297-3888
Mailing Address - Fax:
Practice Address - Street 1:26781 PORTOLA PKWY STE 4E
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1758
Practice Address - Country:US
Practice Address - Phone:949-297-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant