Healthcare Provider Details

I. General information

NPI: 1588287668
Provider Name (Legal Business Name): LESLIE DELACRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13651 HUNTERS OAK DR
ORLANDO FL
32837-7679
US

IV. Provider business mailing address

4508 DAKOTA POINT CT
KISSIMMEE FL
34746-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-5998
  • Fax: 407-730-5999
Mailing address:
  • Phone: 407-580-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT84010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: