Individual
LEANDRA BIBIANA BAZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MT
Contact information
Practice address
1900 16TH ST, GREELEY, CO 80631
(970) 350-2426
(970) 350-2478
Mailing address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2426
(970) 350-2478
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
TN35171
FL
363A00000X
Physician Assistant
Primary
PA0005128
CO
363A00000X
Physician Assistant
PA9103879
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407947286
—
CO
Enumeration date
09/27/2006
Last updated
11/28/2018
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