Provider Demographics
NPI:1326010778
Name:LEAL, MANUEL DIAZ (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:DIAZ
Last Name:LEAL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2531 WHISPERING PALMS LOOP
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1401
Mailing Address - Country:US
Mailing Address - Phone:619-216-0804
Mailing Address - Fax:619-524-0086
Practice Address - Street 1:2650 STOCKTON RD
Practice Address - Street 2:BLD 624
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6000
Practice Address - Country:US
Practice Address - Phone:619-524-1358
Practice Address - Fax:619-524-0086
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA1029908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant