Provider Demographics
NPI:1588059661
Name:DACUYCUY, LEONIEROSE NAMALATA (MD)
Entity type:Individual
Prefix:
First Name:LEONIEROSE
Middle Name:NAMALATA
Last Name:DACUYCUY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 WEST LN STE 221
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3159
Mailing Address - Country:US
Mailing Address - Phone:209-636-5000
Mailing Address - Fax:
Practice Address - Street 1:7912 WEST LN STE 221
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3159
Practice Address - Country:US
Practice Address - Phone:209-636-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144075207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism