Basic Information
| Provider Information | |||||||||
| NPI: | 1679000871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEONARDO HENRIQUEZ M.D P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 NW 12TH AVE # 16960 | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863026352 | ||||||||
| FaxNumber: | 9544325060 | ||||||||
| Practice Location | |||||||||
| Address1: | 13658 DEERING BAY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331582838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863056352 | ||||||||
| FaxNumber: | 9544325060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2017 | ||||||||
| LastUpdateDate: | 05/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | HENRIQUEZ | ||||||||
| AuthorizedOfficialFirstName: | LEONARDO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7863026352 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME90504 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.