Provider Demographics
NPI:1255766184
Name:TORREBLANCA VILLENA, LEISHATT (MD)
Entity type:Individual
Prefix:MRS
First Name:LEISHATT
Middle Name:
Last Name:TORREBLANCA VILLENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MULLIS ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-1154
Mailing Address - Country:US
Mailing Address - Phone:305-989-0103
Mailing Address - Fax:
Practice Address - Street 1:313 W COUNTRY CLUB RD
Practice Address - Street 2:SUITE 13
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5804
Practice Address - Country:US
Practice Address - Phone:575-625-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics