Individual
LENETTE BRANCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10440 SW 146TH ST, MIAMI, FL 33176-7053
(305) 969-0458
Mailing address
10440 SW 146TH ST, MIAMI, FL 33176-7053
(305) 969-0458
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
NTF 0707-7392-06
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230540200
MEDICAID PROVIDER NUMBER
FL
Enumeration date
04/24/2008
Last updated
04/24/2008
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