Individual
MRS. LENETTE FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18921 NW 7TH CT, MIAMI, FL 33169-3803
(305) 770-1734
(305) 653-8558
Mailing address
18921 NW 7TH CT, MIAMI, FL 33169-3803
(305) 770-1734
(305) 653-8558
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
CHA0607-57-03
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230209800
MEDICAID PROVIDER NUMBER
FL
Enumeration date
04/28/2008
Last updated
04/28/2008
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