Healthcare Provider Details

I. General information

NPI: 1326487174
Provider Name (Legal Business Name): LEANA OPPENHEIM D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANA GARIBOVA D.O

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 5TH AVE N STE 202
ST PETERSBURG FL
33705-1410
US

IV. Provider business mailing address

1201 5TH AVE N STE 202
ST PETERSBURG FL
33705
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-7701
  • Fax: 727-820-7700
Mailing address:
  • Phone: 727-820-7701
  • Fax: 727-820-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS017877
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS15188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: