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General NPI Number Information
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NPI Number | 1255152153
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Entity Type | Individual
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Provider Name | GABRIEL DE LEON
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Gender | Male
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 3300 S. UNIVERSITY DRIVE BROWARD
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City | FT LAUDERDALE
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State | FL
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Zip | 33328
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Country | US
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Telephone | 800-541-6682
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Fax |
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Provider Business Mailing Address
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Address Line | URB SABANA GARDENS CALLE 15 #2123 APT 1
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-604-9257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | PSI47435
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License Number State | FL
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