Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1039299 | TX |
NPI | 1033416284 |
---|---|
Provider Name | Mr. William Hernandez Leyva |
First Address | Dallas, TX 75208-4522 |
Second Address | Dallas, TX 75208-4522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2011 |
Last Update Date | 21/12/2021 |