Provider Demographics
NPI:1023614179
Name:ANDARA, LEOPOLDO
Entity type:Individual
Prefix:
First Name:LEOPOLDO
Middle Name:
Last Name:ANDARA
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 1:7641 NW 114TH PL
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1387
Mailing Address - Country:US
Mailing Address - Phone:786-510-0730
Mailing Address - Fax:
Practice Address - Street 1:7641 NW 114TH PL
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1387
Practice Address - Country:US
Practice Address - Phone:786-510-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health