Healthcare Provider Details

I. General information

NPI: 1528490273
Provider Name (Legal Business Name): LESLIE LYNETTE NEVAREZ D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10672 BLOOMINGDALE AVE UNIT 102
RIVERVIEW FL
33578-4291
US

IV. Provider business mailing address

10672 BLOOMINGDALE AVE UNIT 102
RIVERVIEW FL
33578-4291
US

V. Phone/Fax

Practice location:
  • Phone: 813-454-0776
  • Fax:
Mailing address:
  • Phone: 813-454-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 20332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: