Provider Demographics
NPI:1588849335
Name:RICHTER, AURORA LEYVA (MD)
Entity Type:Individual
Prefix:DR
First Name:AURORA
Middle Name:LEYVA
Last Name:RICHTER
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 1:9857 OLD SAINT AUGUSTINE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8821
Mailing Address - Country:US
Mailing Address - Phone:904-260-4461
Mailing Address - Fax:904-292-9684
Practice Address - Street 1:9857 OLD SAINT AUGUSTINE RD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8821
Practice Address - Country:US
Practice Address - Phone:904-861-1900
Practice Address - Fax:904-292-9264
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14229OtherBLUE CROSS BLUE SHIELD
FL280348800Medicaid