Provider Demographics
NPI:1043461676
Name:SANTANA, LEONARDO ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:ALEXANDER
Last Name:SANTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0333
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:100 N EDINBURGH DR STE 200
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4125
Practice Address - Country:US
Practice Address - Phone:407-645-5565
Practice Address - Fax:407-647-1135
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115426207V00000X
FLTRN12938390200000X
FLPA9106234363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008098800Medicaid
FLPA9106234OtherMEDICAL LICENSE
FLGY958ZMedicare PIN