Provider Demographics
NPI:1750774352
Name:ENRIQUEZ GARCIA, LEYANIS
Entity type:Individual
Prefix:
First Name:LEYANIS
Middle Name:
Last Name:ENRIQUEZ GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 NW 80TH CT APT 1311
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2239
Mailing Address - Country:US
Mailing Address - Phone:786-468-6050
Mailing Address - Fax:
Practice Address - Street 1:10090 NW 80TH CT
Practice Address - Street 2:1306
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2255
Practice Address - Country:US
Practice Address - Phone:786-468-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1750774352Medicaid