Provider Demographics
NPI:1023895430
Name:MOTTA, LEILA (DOM)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:MOTTA
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7773 NW 124TH TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4548
Mailing Address - Country:US
Mailing Address - Phone:703-975-9989
Mailing Address - Fax:
Practice Address - Street 1:7773 NW 124TH TER
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4548
Practice Address - Country:US
Practice Address - Phone:703-975-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist