Healthcare Provider Details

I. General information

NPI: 1720834799
Provider Name (Legal Business Name): LLANET GIGLIOLA LORIGA LEIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SW 104TH PATH APT 110
MIAMI FL
33174-3807
US

IV. Provider business mailing address

1550 SW 104TH PATH APT 110
MIAMI FL
33174-3807
US

V. Phone/Fax

Practice location:
  • Phone: 305-339-2854
  • Fax:
Mailing address:
  • Phone: 305-339-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: