MEDICARE: PATRICIA LEAL RNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	AP102364	TX
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	508312	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	508312	OTHER	TX	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689671646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LEAL RNC

Provider Business Mailing Address
First Line	:	367 S GULPH RD
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-3121
Country	:	US
Telephone Number	:	956-489-5050
Fax Number	:	956-252-2029

Provider Business Practice Location Address
First Line	:	10710 MCPHERSON RD STE 304
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6271
Country	:	US
Telephone Number	:	956-489-5050
Fax Number	:	956-252-2029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	04/29/2021

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Directions to “ PATRICIA LEAL RNC” Practice Location

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