Healthcare Provider Details

I. General information

NPI: 1538724182
Provider Name (Legal Business Name): LESLIE MEJIA BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY SUITE #904
POMPANO BEACH FL
33069-5387
US

IV. Provider business mailing address

3385 W 106TH TER
HIALEAH FL
33018-4621
US

V. Phone/Fax

Practice location:
  • Phone: 786-801-7286
  • Fax: 305-397-0308
Mailing address:
  • Phone: 305-903-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: