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NPI Code Detail

MEDICARE: MR. ALVIN LESTER VENGCO LEONARDO PA-C

MEDICARE: MR. ALVIN LESTER VENGCO LEONARDO PA-C
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
1363A00000XPhysician AssistantCA

General Provider Information

NPI Number : 1083565485
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALVIN LESTER VENGCO LEONARDO PA-C
Provider Business Mailing Address
First Line : 6651 MADISON AVE
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-0602
Country : US
Telephone Number : 650-296-1340
Fax Number :
Provider Business Practice Location Address
First Line : 12417 FAIR OAKS BLVD STE 600
Second Line :
City : FAIR OAKS
State : CA
Zip : 95628-2500
Country : US
Telephone Number : 916-727-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/06/2026

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Directions to “ MR. ALVIN LESTER VENGCO LEONARDO PA-C” Practice Location

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