Provider Demographics
NPI:1861298838
Name:FERNANDEZ LEON, PATRICIA DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DE LA CARIDAD
Last Name:FERNANDEZ LEON
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 1:291 E 3RD AVE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4994
Mailing Address - Country:US
Mailing Address - Phone:305-613-1133
Mailing Address - Fax:
Practice Address - Street 1:291 E 3RD AVE UNIT 202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4994
Practice Address - Country:US
Practice Address - Phone:305-613-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1158136106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician