Healthcare Provider Details

I. General information

NPI: 1336790856
Provider Name (Legal Business Name): ARELIS SEIJO LEBRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-2581
  • Fax:
Mailing address:
  • Phone: 786-624-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME167102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: