Doctor Name: | LEONARDO TATO |
NPI Number: | 1336139385 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MPA-C |
License Number: | |
Business Practice Address: | 11th Medical Group 238 Brookley Avenue Bolling Afb, DC - 20032 |
Business Phone Number: | 2027675536 |
Business Fax Number: | |
Mailing Address: | 10901 Rippon Lodge Dr, FAIRFAX |
State: | VA |
Postal Code: | 220322932 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/21/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |