Provider Demographics
NPI:1013563790
Name:LEAL, GABINO VICENTE
Entity Type:Individual
Prefix:
First Name:GABINO
Middle Name:VICENTE
Last Name:LEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E QUAMASIA AVE APT 127
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2632
Mailing Address - Country:US
Mailing Address - Phone:956-570-2127
Mailing Address - Fax:
Practice Address - Street 1:121 E QUAMASIA AVE APT 127
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2632
Practice Address - Country:US
Practice Address - Phone:956-570-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily