Provider Demographics
NPI:1740835644
Name:ALVES ANTUNES, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:ALVES ANTUNES
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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:7551 YOUREE DR STE 11
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5533
Practice Address - Country:US
Practice Address - Phone:318-642-9282
Practice Address - Fax:833-749-0340
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine