Provider Demographics
NPI:1932743101
Name:LEON ABREU, ALEJANDRA
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:LEON ABREU
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 1:8231 SW 107TH AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3708
Mailing Address - Country:US
Mailing Address - Phone:786-523-2384
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE Q
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:305-448-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0291973455Medicaid