Healthcare Provider Details

I. General information

NPI: 1073446514
Provider Name (Legal Business Name): LESLIE PALOMARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E OAKLAND AVE
OAKLAND FL
34787-3070
US

IV. Provider business mailing address

1617 N FULLERS CROSS RD
WINTER GARDEN FL
34787-2123
US

V. Phone/Fax

Practice location:
  • Phone: 407-904-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-288769
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: