Healthcare Provider Details

I. General information

NPI: 1255378634
Provider Name (Legal Business Name): LETICIA ADAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 400
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

4302 ALTON RD SUITE 400
MIAMI BEACH FL
33140-2891
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-1664
  • Fax: 305-531-9965
Mailing address:
  • Phone: 305-531-1664
  • Fax: 305-531-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME49935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: