Provider Demographics
NPI:1689464828
Name:GOMEZ HERNANDEZ, LEIDY LAURA
Entity type:Individual
Prefix:MRS
First Name:LEIDY
Middle Name:LAURA
Last Name:GOMEZ HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 KENDALE LAKES CIR APT B-211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2460
Mailing Address - Country:US
Mailing Address - Phone:786-718-6766
Mailing Address - Fax:
Practice Address - Street 1:13701 KENDALE LAKES CIR APT B-211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2460
Practice Address - Country:US
Practice Address - Phone:786-718-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-434389106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician