Provider Demographics
NPI:1689671646
Name:LEAL, PATRICIA (RNC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:956-489-5050
Mailing Address - Fax:956-252-2029
Practice Address - Street 1:10710 MCPHERSON RD STE 304
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6271
Practice Address - Country:US
Practice Address - Phone:956-489-5050
Practice Address - Fax:956-252-2029
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP102364363LX0001X
TX508312363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508312OtherLICENSE
TX039546903Medicaid
TX8K1158Medicare PIN