Basic Information
| Provider Information | |||||||||
| NPI: | 1376902270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEY | ||||||||
| FirstName: | PAOLA | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3150 PONCE DE LEON BLVD | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331346826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053053321 | ||||||||
| FaxNumber: | 7865049432 | ||||||||
| Practice Location | |||||||||
| Address1: | 1065 NE 125TH STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862210908 | ||||||||
| FaxNumber: | 7862356225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2016 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246YR1600X | FL | N | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Health Info | Registered Record Administrator | 171W00000X | FL | Y | Other Service Providers | Contractor | 174400000X | FL | N | Other Service Providers | Specialist |
No ID Information.