Healthcare Provider Details

I. General information

NPI: 1205916608
Provider Name (Legal Business Name): DIANA LEBRON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 110TH AVE STE 317
MIAMI FL
33172-1930
US

IV. Provider business mailing address

1695 NW 110TH AVE STE 317
MIAMI FL
33172-1930
US

V. Phone/Fax

Practice location:
  • Phone: 305-671-3654
  • Fax:
Mailing address:
  • Phone: 305-671-3654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME156657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: