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NPI Code Detail

MEDICARE: LEONARDO TATO MPA-C

MEDICARE: LEONARDO TATO MPA-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
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1336139385
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARDO TATO MPA-C
Provider Business Mailing Address
First Line : 4375 FAIR LAKES CT
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-4234
Country : US
Telephone Number : 571-533-4487
Fax Number :
Provider Business Practice Location Address
First Line : 4375 FAIR LAKES CT
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-4234
Country : US
Telephone Number : 571-533-4487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 06/04/2025

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Directions to “ LEONARDO TATO MPA-C” Practice Location

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