Provider Demographics
NPI:1659508265
Name:LEYCO-POLICARPIO, JOHANNA VIVIENNE FERRIOLS (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA VIVIENNE
Middle Name:FERRIOLS
Last Name:LEYCO-POLICARPIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOHANNA VIVIENNE
Other - Middle Name:FERRIOLS
Other - Last Name:LEYCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21308 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:281-206-8201
Mailing Address - Fax:281-206-8206
Practice Address - Street 1:21308 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:281-206-8201
Practice Address - Fax:281-206-8206
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1193207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism