Healthcare Provider Details

I. General information

NPI: 1972065167
Provider Name (Legal Business Name): LEERAN BARANESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 S UNIVERSITY DR
DAVIE FL
33328-2000
US

IV. Provider business mailing address

14703 OTSEGO ST
SHERMAN OAKS CA
91403-1440
US

V. Phone/Fax

Practice location:
  • Phone: 954-475-4400
  • Fax:
Mailing address:
  • Phone: 818-990-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME154710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: