Healthcare Provider Details

I. General information

NPI: 1386592657
Provider Name (Legal Business Name): MERCEDES MIGDALIA LEON FLEITAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 NE 15TH AVE
CAPE CORAL FL
33909-7322
US

IV. Provider business mailing address

3544 NE 15TH AVE
CAPE CORAL FL
33909-7322
US

V. Phone/Fax

Practice location:
  • Phone: 786-422-2658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-521934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: