Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 9292581 | FL |
NPI | 1073008843 |
---|---|
Provider Name | Ms. Maria Elena Guerra Leon |
First Address | Miami, FL 33172-5677 |
Second Address | Miami, FL 33172-5677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2018 |
Last Update Date | 25/06/2018 |