Provider Demographics
NPI:1902686389
Name:FLOREZ, LEYDI PATRICIA
Entity Type:Individual
Prefix:
First Name:LEYDI
Middle Name:PATRICIA
Last Name:FLOREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6034 NATIONAL BLVD UNIT 546
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5176
Mailing Address - Country:US
Mailing Address - Phone:305-360-5121
Mailing Address - Fax:
Practice Address - Street 1:6034 NATIONAL BLVD UNIT 546
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-5176
Practice Address - Country:US
Practice Address - Phone:305-360-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA103646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty