Provider Demographics
NPI:1104269299
Name:CIRINO, LEONARDO PHILIP (SFIDC)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:PHILIP
Last Name:CIRINO
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS SAN JACINTO
Mailing Address - Street 2:CG 56
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09587-1176
Mailing Address - Country:US
Mailing Address - Phone:757-943-6538
Mailing Address - Fax:
Practice Address - Street 1:USS SAN JACINTO
Practice Address - Street 2:CG 56
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09587-1176
Practice Address - Country:US
Practice Address - Phone:757-943-6538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman