Provider Demographics
NPI:1750120028
Name:LEAL-ANGELES, SERGIO (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:LEAL-ANGELES
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:LEAL ANGELES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, CRNA
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:4301 W MARKHAM ST # 515
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:501-526-5148
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR104611163W00000X
AR230284367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse