Provider Demographics
NPI:1568051274
Name:LEAL, VANESSA NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICOLE
Last Name:LEAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:NICOLE
Other - Last Name:LEAL RIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4473 PAHEE ST STE L
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2037
Mailing Address - Country:US
Mailing Address - Phone:808-632-0200
Mailing Address - Fax:808-632-0201
Practice Address - Street 1:4473 PAHEE ST STE L
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2037
Practice Address - Country:US
Practice Address - Phone:808-632-0200
Practice Address - Fax:808-632-0201
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-1024363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical