Provider Demographics
NPI:1568061182
Name:FERDINAND, LESTER VIVIAN LEON
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:VIVIAN LEON
Last Name:FERDINAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 S RED RD STE 410
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3644
Mailing Address - Country:US
Mailing Address - Phone:305-595-6316
Mailing Address - Fax:
Practice Address - Street 1:6705 S RED RD STE 410
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3644
Practice Address - Country:US
Practice Address - Phone:305-595-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer