Provider Demographics
NPI:1093852022
Name:LEIDALIS SERVICES INC
Entity Type:Organization
Organization Name:LEIDALIS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-631-1568
Mailing Address - Street 1:215 SW 17TH AVE
Mailing Address - Street 2:SUITE # 312
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3689
Mailing Address - Country:US
Mailing Address - Phone:305-631-1568
Mailing Address - Fax:
Practice Address - Street 1:215 SW 17TH AVE
Practice Address - Street 2:SUITE # 312
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3689
Practice Address - Country:US
Practice Address - Phone:305-631-1568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies