Healthcare Provider Details

I. General information

NPI: 1841281862
Provider Name (Legal Business Name): LEILA SEVILLA-LEGACION WILLIAMS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS LEILA SEVILLA LEGACION

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 AVERY RANCH BLVD SUITE 105
AUSTIN TX
78717-4600
US

IV. Provider business mailing address

15004 AVERY RANCH BLVD SUITE 105
AUSTIN TX
78717-4600
US

V. Phone/Fax

Practice location:
  • Phone: 512-528-7420
  • Fax: 512-528-7421
Mailing address:
  • Phone: 512-528-7420
  • Fax: 512-528-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7515
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2752
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: