Provider Demographics
NPI:1255987848
Name:PERRY, LEILA ALEXANDRA (RN)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:ALEXANDRA
Last Name:PERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ISLAND AVE APT 437
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7965
Mailing Address - Country:US
Mailing Address - Phone:916-759-2610
Mailing Address - Fax:
Practice Address - Street 1:1501 ISLAND AVE APT 437
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7965
Practice Address - Country:US
Practice Address - Phone:916-759-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95179082163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice