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General NPI Number Information
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NPI Number | 1831356468
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Entity Type | Individual
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Provider Name | GWENDOLYN DE LEON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 21110 BISCAYNE BLVD SUITE400
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City | AVENTURA
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State | FL
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Zip | 33180-1227
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Country | US
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Telephone | 305-918-7050
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Fax | 305-918-7051
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Provider Business Mailing Address
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Address Line | 3492 NW 82ND DR
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3575
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Country | US
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Telephone | 832-746-0309
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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 | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | ME124315
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License Number State | FL
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