Provider Demographics
NPI:1114712916
Name:DUARTE-LEAL, DIEGO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:DUARTE-LEAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18605 WALKERS CHOICE RD APT 4
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0546
Mailing Address - Country:US
Mailing Address - Phone:240-615-5945
Mailing Address - Fax:
Practice Address - Street 1:18605 WALKERS CHOICE RD APT 4
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0546
Practice Address - Country:US
Practice Address - Phone:240-615-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD10273631547163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant