Healthcare Provider Details

I. General information

NPI: 1881969095
Provider Name (Legal Business Name): LEYTER LORENZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N SHORE DR
MIAMI BEACH FL
33141-2432
US

IV. Provider business mailing address

560 N SHORE DR
MIAMI BEACH FL
33141-2432
US

V. Phone/Fax

Practice location:
  • Phone: 786-554-6667
  • Fax:
Mailing address:
  • Phone: 786-554-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberMA 66693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: