Provider Demographics
NPI:1295836906
Name:LEIVA, FRANCISCO HERMINIO (MD)
Entity type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:HERMINIO
Last Name:LEIVA
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:H
Other - Last Name:LEIVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:5979 VINELAND RD STE 206
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7855
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:2025-02-26
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