Provider Demographics
NPI:1598198848
Name:CORDERO, LEISHLA SAILY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LEISHLA
Middle Name:SAILY
Last Name:CORDERO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 9 BOX 4154
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9431
Mailing Address - Country:US
Mailing Address - Phone:787-566-1899
Mailing Address - Fax:
Practice Address - Street 1:HC 9 BOX 4154
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-9431
Practice Address - Country:US
Practice Address - Phone:787-566-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant