Provider Demographics
NPI:1013633205
Name:RAMIREZ AVILA, LEIDDY K
Entity Type:Individual
Prefix:
First Name:LEIDDY
Middle Name:K
Last Name:RAMIREZ AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5809
Mailing Address - Country:US
Mailing Address - Phone:786-290-1496
Mailing Address - Fax:
Practice Address - Street 1:2812 ISLAND DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5809
Practice Address - Country:US
Practice Address - Phone:786-290-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1484363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical