Healthcare Provider Details

I. General information

NPI: 1821257056
Provider Name (Legal Business Name): LESLEY DE LA TORRE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 SW 87TH AVE SUITE 200
MIAMI FL
33173-2596
US

IV. Provider business mailing address

2275 BISCAYNE BLVD #806
MIAMI FL
33137-5032
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-5229
  • Fax: 305-274-5751
Mailing address:
  • Phone: 305-274-5229
  • Fax: 305-274-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberOS-10338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: