Provider Demographics
NPI:1073892543
Name:LEON & GONZALEZ, CORP
Entity Type:Organization
Organization Name:LEON & GONZALEZ, CORP
Other - Org Name:DR DANIEL LEON ROUMAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON ROUMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-627-9258
Mailing Address - Street 1:9999 NE 2ND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:787-627-9258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 109767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty