Provider Demographics
NPI:1437425808
Name:PAUL, LETICIA (PA)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MILLER AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-3630
Mailing Address - Country:US
Mailing Address - Phone:347-512-5512
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVE,
Practice Address - Street 2:HARLEM HOSPITAL CENTER
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant