Provider Demographics
NPI:1811632383
Name:LEAL, DESIREE QUINN (LM, CPM)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:QUINN
Last Name:LEAL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3513
Mailing Address - Country:US
Mailing Address - Phone:916-436-6205
Mailing Address - Fax:
Practice Address - Street 1:150 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3513
Practice Address - Country:US
Practice Address - Phone:916-436-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CA670176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula