Provider Demographics
NPI:1467543850
Name:METILDI, LEONARD ANGELO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ANGELO
Last Name:METILDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-522-4940
Mailing Address - Fax:575-522-4932
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-522-4940
Practice Address - Fax:575-522-4932
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157671174400000X
NMMD2009-0745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44778058Medicaid
NM44778058Medicaid