Basic Information
| Provider Information | |||||||||
| NPI: | 1386754265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABANILLA | ||||||||
| FirstName: | LEANDRO | ||||||||
| MiddleName: | TUAZON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3730 PLAZA WAY | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993382718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092216550 | ||||||||
| FaxNumber: | 5095865722 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 PLAZA WAY | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993382718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092216550 | ||||||||
| FaxNumber: | 5092216230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00032181 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1122266 | 05 | WA | MEDICAID | 203198509 | 01 | BLUE CROSS SHIELD | OTHER |