Provider Demographics
NPI:1477883908
Name:LEONARDO, VALETIN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:VALETIN
Middle Name:
Last Name:LEONARDO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MERCY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5191
Mailing Address - Country:US
Mailing Address - Phone:808-379-6093
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GUANTANAMO BAY
Practice Address - Street 2:BOX 205
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09859-1000
Practice Address - Country:US
Practice Address - Phone:0115-399-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant