Provider Demographics
NPI:1780222935
Name:LEAL, JUNIET
Entity Type:Individual
Prefix:
First Name:JUNIET
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-2602
Mailing Address - Country:US
Mailing Address - Phone:239-247-9419
Mailing Address - Fax:
Practice Address - Street 1:305 NW 18TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-2602
Practice Address - Country:US
Practice Address - Phone:239-247-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84-3912767OtherNON EMERGENCY MEDICAL TRANSPORTATION