Provider Demographics
NPI:1578773271
Name:GARCIA RIVERA, LESLIE KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:KATHERINE
Last Name:GARCIA RIVERA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:210-630-2207
Mailing Address - Fax:689-304-0303
Practice Address - Street 1:6336 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7812
Practice Address - Country:US
Practice Address - Phone:407-259-2383
Practice Address - Fax:407-630-6884
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN781208D00000X
PR15781208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN781OtherMEDICAL LICENSE
FL017481100Medicaid