Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME142014 | FL |
NPI | 1023500303 |
---|---|
Provider Name | Lea Remolona |
First Address | Boca Raton, FL 33496 |
Second Address | Boca Raton, FL 33496 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 31/08/2020 |