Provider Demographics
NPI:1376675496
Name:LEONARDO LINCE MD PA
Entity Type:Organization
Organization Name:LEONARDO LINCE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-7700
Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3342
Mailing Address - Country:US
Mailing Address - Phone:210-615-7700
Mailing Address - Fax:
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:SUITE 325
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-615-7700
Practice Address - Fax:210-615-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477594893OtherNPI
TX828785Medicare ID - Type Unspecified
TXC18432Medicare UPIN