Provider Demographics
NPI:1942846738
Name:LEAL, RAMON DAVID SR (LIC)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:DAVID
Last Name:LEAL
Suffix:SR
Gender:M
Credentials:LIC
Other - Prefix:MR
Other - First Name:RAMON
Other - Middle Name:DAVID
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12430 SW 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3838
Mailing Address - Country:US
Mailing Address - Phone:305-338-5917
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF106225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter