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General NPI Number Information
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NPI Number | 1073892543
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Entity Type | Organization
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Legal Business Name | LEON & GONZALEZ, CORP
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 9999 NE 2ND AVE SUITE 204
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2352
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Country | US
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Telephone | 787-627-9258
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Fax |
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Provider Business Mailing Address
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Address Line | 9999 NE 2ND AVE SUITE 204
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2352
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL LEON ROUMAIN
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Credential | M.D.
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Telephone | 787-627-9258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 109767
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License Number State | FL
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