Healthcare Provider Details

I. General information

NPI: 1679321350
Provider Name (Legal Business Name): LESLEI PAOLA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 NW 79TH AVE
DORAL FL
33122-1033
US

IV. Provider business mailing address

3460 SW 113TH PL
MIAMI FL
33165-3414
US

V. Phone/Fax

Practice location:
  • Phone: 305-597-3861
  • Fax:
Mailing address:
  • Phone: 786-461-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-332378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: