Provider Demographics
NPI:1609559541
Name:FIRST RESPONSE LEADS LLC
Entity Type:Organization
Organization Name:FIRST RESPONSE LEADS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-227-6020
Mailing Address - Street 1:12900 SW 128TH ST STE 204B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6274
Mailing Address - Country:US
Mailing Address - Phone:786-227-6020
Mailing Address - Fax:786-544-2790
Practice Address - Street 1:12900 SW 128TH ST STE 204B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6274
Practice Address - Country:US
Practice Address - Phone:786-227-6020
Practice Address - Fax:786-544-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11020559OtherMEDICAL LICENSE