Provider Demographics
NPI:1386754265
Name:CABANILLA, LEANDRO TUAZON (MD)
Entity type:Individual
Prefix:MR
First Name:LEANDRO
Middle Name:TUAZON
Last Name:CABANILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3730 PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2718
Mailing Address - Country:US
Mailing Address - Phone:509-221-6550
Mailing Address - Fax:509-586-5722
Practice Address - Street 1:3730 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2718
Practice Address - Country:US
Practice Address - Phone:509-221-6550
Practice Address - Fax:509-221-6230
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032181208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122266Medicaid
203198509OtherBLUE CROSS SHIELD
203198509OtherBLUE CROSS SHIELD
WAG8878761Medicare PIN