Most Relevant Information
Provider Data
| NPI Number: | 1003547332 |
| Provider Name: | JEREMIAS LEODAN BRISENO |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA17764 |
Most Important Dates
| Enumeration Date: | 06/17/2022 |
| Last Updated: | 08/27/2024 |
Provider Practice Location
5519 DOCTORS DR
EDINBURG
TX
785395563
Practice Location Phone/Fax
| Phone: | 9563628500 |
| Fax: | 9563628529 |
Provider Mailing Location
PO BOX 749
PHARR
TX
785771614
Provider Mailing Phone/Fax
| Phone: | 9563628500 |
| Fax: | 9563628529 |