Healthcare Provider Details

I. General information

NPI: 1700642915
Provider Name (Legal Business Name): MERIDA TOALA LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MERIDA RODRIGUEZ LE

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PALM SPRINGS DR
ALTAMONTE SPRINGS FL
32701-7870
US

IV. Provider business mailing address

2245 SILVER PINES PL
ORLANDO FL
32808-4418
US

V. Phone/Fax

Practice location:
  • Phone: 407-775-2630
  • Fax:
Mailing address:
  • Phone: 407-476-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberFB9796132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: