Provider Demographics
NPI:1275577819
Name:FLEITES, LUIS A (FMD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:FLEITES
Suffix:
Gender:M
Credentials:FMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7182
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:1550 SW 1ST ST
Practice Address - Street 2:SUITE 21-23
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2162
Practice Address - Country:US
Practice Address - Phone:305-642-8325
Practice Address - Fax:305-643-7713
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767066400Medicaid