Healthcare Provider Details

I. General information

NPI: 1033955430
Provider Name (Legal Business Name): LEISHLA MARIE LLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 TERRALINDA ESTS
TRUJILLO ALTO PR
00976-4091
US

IV. Provider business mailing address

36 TERRALINDA ESTS
TRUJILLO ALTO PR
00976-4091
US

V. Phone/Fax

Practice location:
  • Phone: 787-233-3699
  • Fax:
Mailing address:
  • Phone: 787-233-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number38256
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number3094
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6019
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: