Provider Demographics
NPI:1982743589
Name:LEIVA, ORLANDO ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:ENRIQUE
Last Name:LEIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ORLANDO
Other - Middle Name:E
Other - Last Name:LEIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14990 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4381
Mailing Address - Country:US
Mailing Address - Phone:305-323-1812
Mailing Address - Fax:305-229-2844
Practice Address - Street 1:6230 SW 70TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-284-7734
Practice Address - Fax:305-284-7759
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN 366208D00000X
FLACN366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice