Provider Demographics
NPI:1114618089
Name:LEON, GABRIELA ESTHER (DO6754)
Entity Type:Individual
Prefix:MISS
First Name:GABRIELA
Middle Name:ESTHER
Last Name:LEON
Suffix:
Gender:F
Credentials:DO6754
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14192 GOLD BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4394
Mailing Address - Country:US
Mailing Address - Phone:954-515-2741
Mailing Address - Fax:
Practice Address - Street 1:8101 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9021
Practice Address - Country:US
Practice Address - Phone:407-354-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6754156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician