Provider Demographics
NPI:1801880869
Name:PROFENNA, LEONARDO C (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:C
Last Name:PROFENNA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:497 10TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3178
Mailing Address - Country:US
Mailing Address - Phone:830-393-1730
Mailing Address - Fax:830-393-1739
Practice Address - Street 1:497 10TH ST. STE 104
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114
Practice Address - Country:US
Practice Address - Phone:830-393-1400
Practice Address - Fax:830-393-1737
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP21572083A0100X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine