Provider Demographics
NPI:1215670856
Name:ZUNIGA, LEONEL (LADC)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:ZUNIGA
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TOWN SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6088
Mailing Address - Country:US
Mailing Address - Phone:507-646-8970
Mailing Address - Fax:833-974-2090
Practice Address - Street 1:1415 TOWN SQUARE LN
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6088
Practice Address - Country:US
Practice Address - Phone:507-646-8970
Practice Address - Fax:833-974-2090
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)