Provider Demographics
NPI:1396785416
Name:OTERO, LEANDRO LUIS (MD)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:LUIS
Last Name:OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7925 NW 12TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1821
Mailing Address - Country:US
Mailing Address - Phone:305-874-3909
Mailing Address - Fax:305-874-3916
Practice Address - Street 1:15529 BULL RUN RD
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7004
Practice Address - Country:US
Practice Address - Phone:305-328-8922
Practice Address - Fax:786-224-6489
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME88625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine