Healthcare Provider Details

I. General information

NPI: 1063035277
Provider Name (Legal Business Name): LETICIA DURAN GIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SW 8TH ST STE 244
MIAMI FL
33144-4000
US

IV. Provider business mailing address

640 SE 27TH LN
HOMESTEAD FL
33033-5224
US

V. Phone/Fax

Practice location:
  • Phone: 305-909-4872
  • Fax:
Mailing address:
  • Phone: 786-510-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: