Healthcare Provider Details

I. General information

NPI: 1902668601
Provider Name (Legal Business Name): LEONARDO PADIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY BLVD
ST AUGUSTINE FL
32086-5799
US

IV. Provider business mailing address

13990 BARTRAM PARK BLVD UNIT 2107
JACKSONVILLE FL
32258-5573
US

V. Phone/Fax

Practice location:
  • Phone: 800-241-1027
  • Fax:
Mailing address:
  • Phone: 305-878-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: