Provider Demographics
NPI:1548035611
Name:OSIAS, WERLEIGHT M DE MONTAS (PA)
Entity type:Individual
Prefix:
First Name:WERLEIGHT M
Middle Name:DE MONTAS
Last Name:OSIAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29410 N GOLD LN
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5698
Mailing Address - Country:US
Mailing Address - Phone:516-410-5843
Mailing Address - Fax:
Practice Address - Street 1:29410 N GOLD LN
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5698
Practice Address - Country:US
Practice Address - Phone:516-410-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant