Provider Demographics
NPI:1710873633
Name:CUPE, LEANDRO B (N/A)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:B
Last Name:CUPE
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:701 LARCHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2842
Mailing Address - Country:US
Mailing Address - Phone:240-591-2276
Mailing Address - Fax:
Practice Address - Street 1:1300 H ST NE APT 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5687
Practice Address - Country:US
Practice Address - Phone:240-591-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty