Provider Demographics
NPI:1548922875
Name:LEYAN CASTILLO, SANDRA VERONICA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:VERONICA
Last Name:LEYAN CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVENIDA CONDELL 1415
Mailing Address - Street 2:DEPARTAMENTO 213
Mailing Address - City:SANTIAGO
Mailing Address - State:REGIN METROPOLITANA
Mailing Address - Zip Code:8320000
Mailing Address - Country:CL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 TUFTS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2711
Practice Address - Country:US
Practice Address - Phone:617-653-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2327535363LF0000X, 363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse