Healthcare Provider Details

I. General information

NPI: 1205026820
Provider Name (Legal Business Name): LEOPOLDO AUGUSTO CATALA PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 SW 90TH ST STE 201
MIAMI FL
33186-2182
US

IV. Provider business mailing address

PO BOX 198175
ATLANTA GA
30384-8175
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1317
  • Fax:
Mailing address:
  • Phone: 305-335-4135
  • Fax: 305-279-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9109188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: