MEDICARE: DR. LEON POVEDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0082695	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508801242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON POVEDA M.D.

Provider Business Mailing Address
First Line	:	11191 GRANDVIEW MNR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8840
Country	:	US
Telephone Number	:	561-317-2389
Fax Number	:	561-907-6019

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD STE 211
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3275
Country	:	US
Telephone Number	:	561-331-5155
Fax Number	:	877-409-1795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	01/05/2026

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