Provider Demographics
NPI:1447960166
Name:LEO, ERNESTO MANUEL
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:MANUEL
Last Name:LEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16522 SW 97TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5858
Mailing Address - Country:US
Mailing Address - Phone:305-972-0383
Mailing Address - Fax:
Practice Address - Street 1:16522 SW 97TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5858
Practice Address - Country:US
Practice Address - Phone:305-972-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily