Individual provider Active NPI

Alvin Lester Vengco Leonardo, PA-C

  • Physician Assistant
  • Fair Oaks, CA
National Provider Identifier
1083565485
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
12417 Fair Oaks Blvd Ste 600
Fair Oaks, CA 95628-2500
Phone
(916) 727-1400
NPI assigned
Feb 3, 2026
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X CA Primary

Addresses

Primary practice location

12417 Fair Oaks Blvd Ste 600
Fair Oaks, CA 95628-2500

Mailing address

6651 Madison Ave
Carmichael, CA 95608-0602
Phone (650) 296-1340

Other practice location 1

6651 Madison Ave
Carmichael, CA 95608-0602
Phone (916) 903-7520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260410002821 CA Practitioner - Physician Assistant 1456826023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12417 Fair Oaks Blvd
Suite 600
Fair Oaks, CA 95628-2500
Phone (916) 727-1400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FHGHDD/Endpoint/FHGHDD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1770076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1083565485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6651 MADISON AVE",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956080602",
            "telephone_number": "650-296-1340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12417 FAIR OAKS BLVD STE 600",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956282500",
            "telephone_number": "916-727-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6651 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Carmichael",
            "state": "CA",
            "postal_code": "956080602",
            "country_code": "US",
            "telephone_number": "916-903-7520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEONARDO",
        "first_name": "ALVIN LESTER",
        "middle_name": "VENGCO",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-02-03",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Oaks, CA

Sources for this page

Verify at the official NPI Registry.