Healthcare Provider Details

I. General information

NPI: 1386721181
Provider Name (Legal Business Name): AVITAL LEIBOVICI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 1ST AVE
OCALA FL
34471-6504
US

IV. Provider business mailing address

1500 SW 1ST AVE
OCALA FL
34471-6504
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2528
  • Fax: 407-303-2760
Mailing address:
  • Phone: 407-303-2528
  • Fax: 407-303-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME99383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: