MEDICARE: LESLIE CAROL HOUGHTON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9104413	FL

General Provider Information

NPI Number	:	1417134081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE CAROL HOUGHTON PA-C

Provider Business Mailing Address
First Line	:	301 NE 167TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2304
Country	:	US
Telephone Number	:	305-940-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 NE 167TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2304
Country	:	US
Telephone Number	:	305-940-0522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2008
Last Update Date	:	02/25/2026

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