Healthcare Provider Details

I. General information

NPI: 1770492621
Provider Name (Legal Business Name): LIZ MARIAN LEAL SORI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16801 NW 67TH AVE
HIALEAH FL
33015-4203
US

IV. Provider business mailing address

20048 NW 85TH AVE
HIALEAH FL
33015-6933
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-9522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: