Provider Demographics
NPI:1437906880
Name:SIERRA RODRIGUEZ, LEONARDO JAVIER (TLHT PHYSICIAN ASSIS)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:JAVIER
Last Name:SIERRA RODRIGUEZ
Suffix:
Gender:M
Credentials:TLHT PHYSICIAN ASSIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16378 NW 86TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16378 NW 86TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6146
Practice Address - Country:US
Practice Address - Phone:786-800-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant