Provider Demographics
NPI:1275394231
Name:NOGUERA JIMENEZ, LEONARDO ESTEBAN (ITDS)
Entity Type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:ESTEBAN
Last Name:NOGUERA JIMENEZ
Suffix:
Gender:M
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 CYPRESS LAKE BLVD APT K
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5088
Mailing Address - Country:US
Mailing Address - Phone:954-940-0035
Mailing Address - Fax:
Practice Address - Street 1:641 CYPRESS LAKE BLVD APT K
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5088
Practice Address - Country:US
Practice Address - Phone:954-940-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist