Provider Demographics
NPI:1619484805
Name:ZELLNER DIMINO LEYVA LOPEZ BEECHAM LEYVA JOHNSON
Entity type:Organization
Organization Name:ZELLNER DIMINO LEYVA LOPEZ BEECHAM LEYVA JOHNSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-8222
Mailing Address - Street 1:9595 N KENDALL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1979
Mailing Address - Country:US
Mailing Address - Phone:305-279-8222
Mailing Address - Fax:305-270-9030
Practice Address - Street 1:9595 N KENDALL DR STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1979
Practice Address - Country:US
Practice Address - Phone:305-279-8222
Practice Address - Fax:305-270-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty