Individual provider Active NPI

Luciano Oquendo III, MD

  • Family Medicine Physician
  • Leesburg, FL
National Provider Identifier
1053355297
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
13694 Issued in PR
Practice address
711 W Main St
Leesburg, FL 34748-5128
Phone
(352) 435-4000
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 13694 PR Primary

Addresses

Primary practice location

711 W Main St
Leesburg, FL 34748-5128

Mailing address

711 W Main St
Leesburg, FL 34748-5128
Phone (352) 435-4000

Other names 1

  • Luciano Oquendo Santiago Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190627000264 FL Order and Referring Only - Family PracticePractitioner - Family Practice 3577529890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317168000000",
    "number": "1053355297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W MAIN ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485128",
            "telephone_number": "352-435-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W MAIN ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485128",
            "telephone_number": "352-435-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OQUENDO",
        "first_name": "LUCIANO",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2011-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PR",
            "license": "13694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LUCIANO",
            "last_name": "OQUENDO SANTIAGO",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.