Provider Demographics
NPI:1790800969
Name:LEAL, AVELINO O (MD)
Entity Type:Individual
Prefix:
First Name:AVELINO
Middle Name:O
Last Name:LEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2005 W RUTHRAUFF RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-4864
Mailing Address - Country:US
Mailing Address - Phone:520-293-7250
Mailing Address - Fax:520-293-7234
Practice Address - Street 1:2005 W RUTHRAUFF RD
Practice Address - Street 2:SUITE 111
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-4864
Practice Address - Country:US
Practice Address - Phone:520-293-7250
Practice Address - Fax:520-293-7234
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ300392083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120952Medicare PIN
AZZ133254Medicare UPIN