Provider Demographics
NPI:1528860848
Name:LEIVA LUNA, NORBERTO E
Entity type:Individual
Prefix:
First Name:NORBERTO
Middle Name:E
Last Name:LEIVA LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 HERITAGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-5118
Mailing Address - Country:US
Mailing Address - Phone:813-403-0781
Mailing Address - Fax:
Practice Address - Street 1:2107 HERITAGE CREST DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-5118
Practice Address - Country:US
Practice Address - Phone:813-403-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03250277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty