Healthcare Provider Details

I. General information

NPI: 1265247191
Provider Name (Legal Business Name): LEONEL DEULOFEU DEULOFEU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8451 MANTA RAY CIR
CYPRESS TX
77433-3228
US

IV. Provider business mailing address

7206 ANAQUITAS CREEK CT
RICHMOND TX
77407-7140
US

V. Phone/Fax

Practice location:
  • Phone: 786-804-1761
  • Fax:
Mailing address:
  • Phone: 786-804-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-82750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: