Provider Demographics
NPI:1144996448
Name:MAS, LETICIA (APRN)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:MAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 NW 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI GAEDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6135
Mailing Address - Country:US
Mailing Address - Phone:786-858-7800
Mailing Address - Fax:786-549-0170
Practice Address - Street 1:5612 NW 167TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33014-6135
Practice Address - Country:US
Practice Address - Phone:786-858-7800
Practice Address - Fax:786-549-0170
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014877363LF0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily