Provider Demographics
NPI:1841281862
Name:WILLIAMS, LEILA SEVILLA-LEGACION (DO)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:SEVILLA-LEGACION
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:LEILA
Other - Middle Name:SEVILLA
Other - Last Name:LEGACION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15004 AVERY RANCH BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4600
Mailing Address - Country:US
Mailing Address - Phone:512-528-7420
Mailing Address - Fax:512-528-7421
Practice Address - Street 1:15004 AVERY RANCH BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4600
Practice Address - Country:US
Practice Address - Phone:512-528-7420
Practice Address - Fax:512-528-7421
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7515207Q00000X
TXL2752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN