Healthcare Provider Details

I. General information

NPI: 1346287729
Provider Name (Legal Business Name): LETICIA ADAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 420
MIAMI BEACH FL
33140-2849
US

IV. Provider business mailing address

4302 ALTON RD STE 420
MIAMI BEACH FL
33140-2849
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-1664
  • Fax: 305-531-9965
Mailing address:
  • Phone: 305-216-5048
  • Fax: 305-531-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARISSE MAJELLA DISTURA JINGCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-531-1664