| Lester De Leon Md Pa | |
|
4155 Sw 136th Ave Miami FL 33175-3253 | |
| (786) 536-7614 | |
| Not Available |
| Full Name | Lester De Leon Md Pa |
|---|---|
| Speciality | General Practice |
| Location | 4155 Sw 136th Ave, Miami, Florida |
| Authorized Official Name and Position | Lester De Leon (PRESIDENT) |
| Authorized Official Contact | 7862595449 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lester De Leon Md Pa 4155 Sw 136th Ave Miami FL 33175-3253 Ph: () - | Lester De Leon Md Pa 4155 Sw 136th Ave Miami FL 33175-3253 Ph: (786) 536-7614 |
| NPI Number | 1164796090 |
|---|---|
| Provider Enumeration Date | 02/23/2012 |
| Last Update Date | 02/23/2012 |
| Medicare PECOS PAC ID | 4880982198 |
|---|---|
| Medicare Enrollment ID | O20161019000438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164796090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME111208 (Florida) | Primary |
| Provider Name | Lester M De Leon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912135419 PECOS PAC ID: 8628241320 Enrollment ID: I20121102000460 |
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