Healthcare Provider Details

I. General information

NPI: 1851881254
Provider Name (Legal Business Name): MR. LEONARDO ANOCETO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14572 SW 155TH PL
MIAMI FL
33196-2886
US

IV. Provider business mailing address

14572 SW 155TH PL
MIAMI FL
33196-2886
US

V. Phone/Fax

Practice location:
  • Phone: 786-294-8038
  • Fax:
Mailing address:
  • Phone: 786-294-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54909
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: