Provider Demographics
NPI:1396177713
Name:BUMANGLAG, LEILA OLIVIA GINO-GINO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILA OLIVIA
Middle Name:GINO-GINO
Last Name:BUMANGLAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEILA OLIVIA
Other - Middle Name:DE LOS REYES
Other - Last Name:GINO-GINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 EMANCIPATION DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667-0001
Mailing Address - Country:US
Mailing Address - Phone:757-722-9961
Mailing Address - Fax:757-315-3431
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-4629
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:757-315-3431
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine