| Leocadio B Penalosa Jr | |
|
301 Goode Way Ste 204 Portsmouth VA 23704 | |
| (757) 397-5301 | |
| (757) 397-9536 |
| Full Name | Leocadio B Penalosa Jr |
|---|---|
| Speciality | Family Medicine |
| Location | 301 Goode Way, Portsmouth, Virginia |
| Authorized Official Name and Position | Leocadio B Penalosa (PHYSICIAN OWNER) |
| Authorized Official Contact | 7573975301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leocadio B Penalosa Jr 301 Goode Way Ste 204 Portsmouth VA 23704 Ph: (757) 397-5301 | Leocadio B Penalosa Jr 301 Goode Way Ste 204 Portsmouth VA 23704 Ph: (757) 397-5301 |
| NPI Number | 1487721445 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 06/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487721445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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