Provider Demographics
NPI:1073636007
Name:LEAL, VIRGINIA (CFTS, CFO)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:CFTS, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 MEXICO AVE.
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-6060
Mailing Address - Country:US
Mailing Address - Phone:956-712-1556
Mailing Address - Fax:
Practice Address - Street 1:6801 MCPHERSON RD
Practice Address - Street 2:222
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6402
Practice Address - Country:US
Practice Address - Phone:956-722-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01398174400000X
DE0074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist