Healthcare Provider Details

I. General information

NPI: 1528947256
Provider Name (Legal Business Name): MR. LEO ALLEN ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LOUISIANA PURPOSE

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 XAVIER CT
ORLANDO FL
32826-3426
US

IV. Provider business mailing address

2904 XAVIER CT
ORLANDO FL
32826-3426
US

V. Phone/Fax

Practice location:
  • Phone: 347-287-2244
  • Fax:
Mailing address:
  • Phone: 347-287-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number01002066P
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: