Provider Demographics
NPI:1275706822
Name:RIZALINA LEUTERIO MD P A
Entity Type:Organization
Organization Name:RIZALINA LEUTERIO MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIZALINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEUTERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:386-760-8116
Mailing Address - Street 1:711 BEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1823
Mailing Address - Country:US
Mailing Address - Phone:386-760-8116
Mailing Address - Fax:386-760-0532
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:386-760-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF47132Medicare UPIN
FL18306AMedicare PIN