Provider Demographics
NPI:1487104758
Name:SILVA, MICHELLE LEIGH
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEIGH
Last Name:SILVA
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 1:400 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4353
Mailing Address - Country:US
Mailing Address - Phone:805-682-7111
Mailing Address - Fax:
Practice Address - Street 1:802 E SAUNDERS ST STE A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5824
Practice Address - Country:US
Practice Address - Phone:956-568-5013
Practice Address - Fax:956-701-3006
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019516363LF0000X
TXAP125520363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP125520OtherSTATE LICENSE NUMBER