Healthcare Provider Details

I. General information

NPI: 1215809082
Provider Name (Legal Business Name): LEIDIANA MOYA MISA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 SW 210TH ST APT A504
CUTLER BAY FL
33189-4019
US

IV. Provider business mailing address

7900 SW 210TH ST APT A504
CUTLER BAY FL
33189-4019
US

V. Phone/Fax

Practice location:
  • Phone: 305-484-7078
  • Fax:
Mailing address:
  • Phone: 305-484-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-469041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: