Provider Demographics
NPI:1295836906
Name:LEIVA, FRANCISCO HERMNIO
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:HERMNIO
Last Name:LEIVA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:FRANCISCO
Other - Middle Name:HERMINIO
Other - Last Name:LEIVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5979 VINELAND RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7800
Mailing Address - Country:US
Mailing Address - Phone:407-352-9300
Mailing Address - Fax:407-351-6509
Practice Address - Street 1:5979 VINELAND RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7800
Practice Address - Country:US
Practice Address - Phone:407-352-9300
Practice Address - Fax:407-351-6509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037023100Medicaid
FLD58631Medicare UPIN