Provider Demographics
NPI:1699883157
Name:APODACA, LEONEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEONEL
Middle Name:
Last Name:APODACA
Suffix:JR
Gender:M
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:P O BOX 495
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210
Mailing Address - Country:US
Mailing Address - Phone:559-935-4374
Mailing Address - Fax:559-935-4316
Practice Address - Street 1:1145 PHELPS AVENUE
Practice Address - Street 2:# 104
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210
Practice Address - Country:US
Practice Address - Phone:559-935-4374
Practice Address - Fax:559-935-4316
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA553916Medicare Oscar/Certification
CA553927Medicare Oscar/Certification