Provider Demographics
NPI:1154089068
Name:LEAL, DESIREE JAYNE DOMINGO (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:DESIREE JAYNE
Middle Name:DOMINGO
Last Name:LEAL
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1258
Mailing Address - Country:US
Mailing Address - Phone:661-885-6060
Mailing Address - Fax:
Practice Address - Street 1:212 COFFEE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1258
Practice Address - Country:US
Practice Address - Phone:661-885-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF11210766363LF0000X
CA2021104508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily