Provider Demographics
NPI:1255921185
Name:PEDRAZA GONZALEZ, LEIDI MAYLAN (MD)
Entity type:Individual
Prefix:
First Name:LEIDI
Middle Name:MAYLAN
Last Name:PEDRAZA GONZALEZ
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:561-477-7000
Mailing Address - Fax:561-477-7707
Practice Address - Street 1:19615 STATE ROAD 7 STE 32
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4700
Practice Address - Country:US
Practice Address - Phone:561-477-7000
Practice Address - Fax:561-477-7707
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME168881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics