MEDICARE: G&D PPEC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	261QM3000X	Medically Fragile Infants and Children Day Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518444595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G&D PPEC

Provider Business Mailing Address
First Line	:	14201 S DIXIE HWY
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33176-7224
Country	:	US
Telephone Number	:	305-978-6309
Fax Number	:

Provider Business Practice Location Address
First Line	:	14201 S DIXIE HWY
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33176-7224
Country	:	US
Telephone Number	:	305-978-6309
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARCELO LEON
Credential	:
Telephone Number	:	786-554-8494

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	05/22/2024

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Directions to “G&D PPEC ” Practice Location

Language	Start Address	Practice Location

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