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General NPI Number Information
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NPI Number | 1518329911
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Entity Type | Individual
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Provider Name | LEODAN LANTIGUA SR.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 960 SW 82 AVE
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City | MIAMI
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State | FL
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Zip | 33144
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Country | US
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Telephone | 305-266-7556
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Fax | 305-266-7557
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Provider Business Mailing Address
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Address Line | PO BOX 440846
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City | MIAMI
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State | FL
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Zip | 33144-0846
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Country | US
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Telephone | 305-266-7556
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Fax | 305-266-7557
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS12142
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC8713
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License Number State | FL
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