Provider Demographics
NPI:1275626806
Name:H & L MEDICAL CENTER
Entity Type:Organization
Organization Name:H & L MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:LEIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-8687
Mailing Address - Street 1:P.O. BOX 522483
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33152-2483
Mailing Address - Country:US
Mailing Address - Phone:305-323-1812
Mailing Address - Fax:305-223-3579
Practice Address - Street 1:14990 S.W. 43RD STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4381
Practice Address - Country:US
Practice Address - Phone:305-323-1812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9100304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2919401 00Medicaid