Provider Demographics
NPI:1629573795
Name:LEONI, ROBERTO (DO)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:LEONI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3006
Mailing Address - Country:US
Mailing Address - Phone:305-332-8027
Mailing Address - Fax:
Practice Address - Street 1:ONE NETANYA BLDG 323 SUNNY ISLES BLVD
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160
Practice Address - Country:US
Practice Address - Phone:786-274-8105
Practice Address - Fax:786-274-8905
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS17539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program