Healthcare Provider Details

I. General information

NPI: 1942327580
Provider Name (Legal Business Name): LEOPOLDO HENRIQUE CATALA PA-C, MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CAMPO SANO AVE STE 200
CORAL GABLES FL
33146-1174
US

IV. Provider business mailing address

11801SW90TH ST 201
MIAMI FL
33186-2182
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-6200
  • Fax:
Mailing address:
  • Phone: 305-595-1317
  • Fax: 305-279-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108119
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: