Provider Demographics
NPI:1982412771
Name:LEAL, HEIDI GABRIELA
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:GABRIELA
Last Name:LEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 HELENA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5320
Mailing Address - Country:US
Mailing Address - Phone:805-458-4246
Mailing Address - Fax:
Practice Address - Street 1:2410 HELENA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5320
Practice Address - Country:US
Practice Address - Phone:805-458-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA022466171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter