Provider Demographics
NPI:1538642129
Name:FUA, LEONARDO GARCIA JR
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:GARCIA
Last Name:FUA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4645
Mailing Address - Country:US
Mailing Address - Phone:720-775-0706
Mailing Address - Fax:
Practice Address - Street 1:2013 GROVE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4645
Practice Address - Country:US
Practice Address - Phone:720-775-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide