Provider Demographics
NPI:1821257056
Name:DE LA TORRE, LESLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 BISCAYNE BLVD
Mailing Address - Street 2:#806
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5032
Mailing Address - Country:US
Mailing Address - Phone:305-274-5229
Mailing Address - Fax:305-274-5751
Practice Address - Street 1:7765 SW 87TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2596
Practice Address - Country:US
Practice Address - Phone:305-274-5229
Practice Address - Fax:305-274-5751
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-10338207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56425058Medicaid