Provider Demographics
NPI:1588196240
Name:DE LEON, KAREL MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:KAREL
Middle Name:MANUEL
Last Name:DE LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KAREL
Other - Middle Name:MANUEL
Other - Last Name:DE LEON LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9920 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3944
Mailing Address - Country:US
Mailing Address - Phone:786-360-4425
Mailing Address - Fax:786-360-4461
Practice Address - Street 1:9920 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3944
Practice Address - Country:US
Practice Address - Phone:786-360-4425
Practice Address - Fax:786-360-4461
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1550932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL155093OtherLICENSE