Provider Demographics
NPI:1154793321
Name:LEIRA, JUAN
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:LEIRA
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 1:18782 NW 79TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5297
Mailing Address - Country:US
Mailing Address - Phone:786-376-5234
Mailing Address - Fax:
Practice Address - Street 1:18782 NW 79TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5297
Practice Address - Country:US
Practice Address - Phone:786-376-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator