Healthcare Provider Details

I. General information

NPI: 1588849335
Provider Name (Legal Business Name): AURORA LEYVA RICHTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9857 OLD SAINT AUGUSTINE RD STE 4
JACKSONVILLE FL
32257-8821
US

IV. Provider business mailing address

9857 OLD SAINT AUGUSTINE RD STE 1
JACKSONVILLE FL
32257-8821
US

V. Phone/Fax

Practice location:
  • Phone: 904-861-1900
  • Fax: 904-292-9264
Mailing address:
  • Phone: 904-260-4461
  • Fax: 904-292-9684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME100592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: