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General NPI Number Information
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NPI Number | 1548845282
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Entity Type | Individual
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Provider Name | CAMILO GOMEZ LEON APRN
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Gender | Male
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 14334 SW 177TH ST
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City | MIAMI
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State | FL
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Zip | 33177-2620
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Country | US
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Telephone | 786-333-6504
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Fax |
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Provider Business Mailing Address
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Address Line | 14334 SW 177TH ST
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City | MIAMI
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State | FL
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Zip | 33177-2620
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Country | US
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Telephone | 786-333-6504
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11030249
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11030249
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License Number State | FL
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