Healthcare Provider Details

I. General information

NPI: 1386508620
Provider Name (Legal Business Name): LEO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7198 LAUREL CHERRY CT
COLORADO SPRINGS CO
80927-4012
US

IV. Provider business mailing address

7198 LAUREL CHERRY CT
COLORADO SPRINGS CO
80927-4012
US

V. Phone/Fax

Practice location:
  • Phone: 719-322-1448
  • Fax: 719-322-1448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: