Healthcare Provider Details

I. General information

NPI: 1518619683
Provider Name (Legal Business Name): LEIDY ESQUIVEL GAMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NW 17TH AVE STE 272
DELRAY BEACH FL
33445-2562
US

IV. Provider business mailing address

1912 LAURA LN
WEST PALM BEACH FL
33406-6638
US

V. Phone/Fax

Practice location:
  • Phone: 786-675-2415
  • Fax:
Mailing address:
  • Phone: 786-675-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: