Provider Demographics
NPI:1285002840
Name:LEAL, MARISA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:5138 MONTEREY HWY STE G
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-4382
Mailing Address - Country:US
Mailing Address - Phone:408-687-4806
Mailing Address - Fax:408-687-4817
Practice Address - Street 1:3466 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2809
Practice Address - Country:US
Practice Address - Phone:408-791-1210
Practice Address - Fax:408-791-0085
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA55120363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical