Provider Demographics
NPI:1235434572
Name:HORACE A LEYVA MDPA
Entity Type:Organization
Organization Name:HORACE A LEYVA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HORACIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-823-3535
Mailing Address - Street 1:PO BOX 5317
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-1317
Mailing Address - Country:US
Mailing Address - Phone:305-823-3535
Mailing Address - Fax:305-823-6551
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:606
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-823-3535
Practice Address - Fax:305-823-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15227208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049249300Medicaid
FLD64180Medicare UPIN