Provider Demographics
NPI:1346432911
Name:LEAL, MARY ALICE D (MA)
Entity Type:Individual
Prefix:
First Name:MARY ALICE
Middle Name:D
Last Name:LEAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1202 E SOTERRA BLVD, STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-400-7701
Mailing Address - Fax:210-828-6679
Practice Address - Street 1:1202 E SOTERRA BLVD, STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4090
Practice Address - Country:US
Practice Address - Phone:210-400-7701
Practice Address - Fax:210-828-6679
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical