Healthcare Provider Details

I. General information

NPI: 1164173092
Provider Name (Legal Business Name): LEOLVIS ZURITA LEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 SE 5TH CT
HOMESTEAD FL
33033-7227
US

IV. Provider business mailing address

3204 SE 5TH CT
HOMESTEAD FL
33033-7227
US

V. Phone/Fax

Practice location:
  • Phone: 786-600-5429
  • Fax:
Mailing address:
  • Phone: 786-600-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-126286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: