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General NPI Number Information
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NPI Number | 1295492957
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Entity Type | Individual
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Provider Name | LEO BACA JR. RPA
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Gender | Male
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 25455 MEDICAL CENTER DR
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City | MURRIETA
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State | CA
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Zip | 92562-1500
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Country | US
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Telephone | 951-587-8956
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Fax |
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Provider Business Mailing Address
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Address Line | 35081 HULIHEE ST
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City | WINCHESTER
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State | CA
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Zip | 92596-8514
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Country | US
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Telephone | 303-944-3764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number |
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License Number State |
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