Healthcare Provider Details

I. General information

NPI: 1396785416
Provider Name (Legal Business Name): LEANDRO LUIS OTERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15529 BULL RUN RD
MIAMI LAKES FL
33014-7004
US

IV. Provider business mailing address

7925 NW 12TH ST STE 201
DORAL FL
33126-1821
US

V. Phone/Fax

Practice location:
  • Phone: 305-328-8922
  • Fax: 786-224-6489
Mailing address:
  • Phone: 305-874-3909
  • Fax: 305-874-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME88625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: