1912557737 NPI number — ADRIANA DEL CARMEN LEQUERICA ZIEMBA DOCTOR OF PSYCHOLOGY

Table of content: ADRIANA DEL CARMEN LEQUERICA ZIEMBA DOCTOR OF PSYCHOLOGY (NPI 1912557737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912557737 NPI number — ADRIANA DEL CARMEN LEQUERICA ZIEMBA DOCTOR OF PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEQUERICA ZIEMBA
Provider First Name:
ADRIANA
Provider Middle Name:
DEL CARMEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DOCTOR OF PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912557737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 N FLAGLER DR STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33401-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-804-5682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
941 SE 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE GLADE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33430-4353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-642-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY10419 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104360800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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