Healthcare Provider Details

I. General information

NPI: 1093639262
Provider Name (Legal Business Name): RETROMODERNO PRIMARY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 NW 95TH ST STE 109
HIALEAH GARDENS FL
33016-2360
US

IV. Provider business mailing address

8040 NW 95TH ST STE 109
HIALEAH GARDENS FL
33016-2360
US

V. Phone/Fax

Practice location:
  • Phone: 786-414-0990
  • Fax: 786-558-5896
Mailing address:
  • Phone: 786-414-0990
  • Fax: 786-558-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YULIET VARONA LEYVA
Title or Position: OWNER
Credential: APRN, FNP-C
Phone: 786-414-0990