Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 14748 | TX |
Y | 1223G0001X | General Practice | 14748 | TX |
Y | 213EG0000X | General Practice | 14748 | TX |
NPI | 1003165994 |
---|---|
Provider Name | Dr. Leo Luis Figueroa |
First Address | Alamo, TX 78516-3704 |
Second Address | Alamo, TX 78516-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
090908703 | (05) | TX |