Provider Demographics
NPI:1326487174
Name:OPPENHEIM, LEANA (DO)
Entity Type:Individual
Prefix:DR
First Name:LEANA
Middle Name:
Last Name:OPPENHEIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LEANA
Other - Middle Name:
Other - Last Name:GARIBOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1201 5TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705
Mailing Address - Country:US
Mailing Address - Phone:727-820-7701
Mailing Address - Fax:727-820-7700
Practice Address - Street 1:1201 5TH AVE N STE 202
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1410
Practice Address - Country:US
Practice Address - Phone:727-820-7701
Practice Address - Fax:727-820-7700
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0178772084N0400X
FLOS151882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100572100Medicaid