Basic Information
| Provider Information | |||||||||
| NPI: | 1790800969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAL | ||||||||
| FirstName: | AVELINO | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 W RUTHRAUFF RD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857054864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202937250 | ||||||||
| FaxNumber: | 5202937234 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 W RUTHRAUFF RD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857054864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202937250 | ||||||||
| FaxNumber: | 5202937234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 30039 | AZ | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.