Healthcare Provider Details

I. General information

NPI: 1487496303
Provider Name (Legal Business Name): LEANDRO ESCANDELL ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5416 SW 142ND PL
MIAMI FL
33175-5833
US

IV. Provider business mailing address

5416 SW 142ND PL
MIAMI FL
33175-5833
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-9612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: