Provider Demographics
NPI:1922079573
Name:ALLENDE, LEONARDO M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:M
Last Name:ALLENDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 NW 97TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2911
Mailing Address - Country:US
Mailing Address - Phone:786-801-1168
Mailing Address - Fax:786-801-1176
Practice Address - Street 1:4055 NW 97TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2911
Practice Address - Country:US
Practice Address - Phone:786-801-1168
Practice Address - Fax:786-801-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27841207L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056752300Medicaid
FL25024OtherB/S FL & HEALTH OPTIONS
FL25024WMedicare ID - Type Unspecified
FLE19684Medicare UPIN