Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | ORF106 | FL |
NPI | 1942846738 |
---|---|
Provider Name | Mr. Ramon David Leal SR. |
First Address | Miami, FL 33177-3838 |
Second Address | Miami, FL 33125-1624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2019 |
Last Update Date | 27/11/2019 |