Provider Demographics
NPI:1295492957
Name:BACA, LEO JR (RPA)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:BACA
Suffix:JR
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35081 HULIHEE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8514
Mailing Address - Country:US
Mailing Address - Phone:303-944-3764
Mailing Address - Fax:
Practice Address - Street 1:25455 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1500
Practice Address - Country:US
Practice Address - Phone:951-587-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA243U00000XOtherCBRPA RPA