Provider Demographics
NPI:1740060177
Name:LEAL, JUAN DE DIOS
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:DE DIOS
Last Name:LEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:GARCIASVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78547-1115
Mailing Address - Country:US
Mailing Address - Phone:956-844-4166
Mailing Address - Fax:
Practice Address - Street 1:301 EAST FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-632-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144941367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered