MEDICARE: LEONARDO JAVIER SIERRA RODRIGUEZ TLHT PHYSICIAN ASSIS

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	363A00000X	Physician Assistant	TPPA584	FL

General Provider Information

NPI Number	:	1437906880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARDO JAVIER SIERRA RODRIGUEZ TLHT PHYSICIAN ASSIS

Provider Business Mailing Address
First Line	:	16378 NW 86TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-6146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16378 NW 86TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-6146
Country	:	US
Telephone Number	:	786-800-7631
Fax Number	:

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

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	05/03/2024

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