Provider Demographics
NPI:1407365174
Name:LEON, GABRIELA R
Entity Type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:R
Last Name:LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BOATHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-2045
Mailing Address - Country:US
Mailing Address - Phone:331-222-6041
Mailing Address - Fax:
Practice Address - Street 1:486 RANDALL RD UNIT B
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3354
Practice Address - Country:US
Practice Address - Phone:224-783-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF08171104363LF0000X
IL209-016713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily