Provider Demographics
NPI:1649762436
Name:LEAL, MARIBEL (LVN)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2014
Mailing Address - Country:US
Mailing Address - Phone:956-821-7630
Mailing Address - Fax:
Practice Address - Street 1:2609 NESSUH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-4814
Practice Address - Country:US
Practice Address - Phone:956-630-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208058164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse