Provider Demographics
NPI:1255378634
Name:ADAN, LETICIA (MD)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:
Last Name:ADAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-531-1664
Mailing Address - Fax:305-531-9965
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-531-1664
Practice Address - Fax:305-531-9965
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49935207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL130016622OtherRAILROAD MEDICARE
FL045911900Medicaid
FL02821OtherBCBS
FL045911900Medicaid
FL02821OtherBCBS