Healthcare Provider Details

I. General information

NPI: 1710873633
Provider Name (Legal Business Name): LEANDRO B CUPE N/A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: N/A N/A N/A N/A

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 H ST NE APT 210
WASHINGTON DC
20002-5687
US

IV. Provider business mailing address

701 LARCHMONT AVE
CAPITOL HEIGHTS MD
20743-2842
US

V. Phone/Fax

Practice location:
  • Phone: 240-591-2276
  • Fax:
Mailing address:
  • Phone: 240-591-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: