Provider Demographics
NPI:1275244642
Name:CAVALLIN, LEONORA (DO7170)
Entity Type:Individual
Prefix:
First Name:LEONORA
Middle Name:
Last Name:CAVALLIN
Suffix:
Gender:F
Credentials:DO7170
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 NW 102ND AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2204
Mailing Address - Country:US
Mailing Address - Phone:786-296-5220
Mailing Address - Fax:
Practice Address - Street 1:15470 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5823
Practice Address - Country:US
Practice Address - Phone:305-456-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7170156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician