Healthcare Provider Details

I. General information

NPI: 1871439547
Provider Name (Legal Business Name): LEON JEROME BAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 NW 75TH ST
MIAMI FL
33147-6025
US

IV. Provider business mailing address

1901 NW 152ND ST
OPA LOCKA FL
33054-2911
US

V. Phone/Fax

Practice location:
  • Phone: 305-637-6400
  • Fax: 305-691-1183
Mailing address:
  • Phone: 305-637-6400
  • Fax: 305-691-1183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: