Provider Demographics
NPI:1275579021
Name:LEUTERIO, RIZALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZALINA
Middle Name:
Last Name:LEUTERIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:711 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1823
Practice Address - Country:US
Practice Address - Phone:386-760-8116
Practice Address - Fax:888-486-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18306OtherBCBS #
FL4203OtherHUMANA
FL653442OtherAETNA #
FL593545051OtherTAX ID
FL653442OtherAETNA #
FL18306AMedicare ID - Type UnspecifiedMEDICARE #