Provider Demographics
NPI:1881843860
Name:TOSADO DE LEON, KEILA THAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEILA
Middle Name:THAMAR
Last Name:TOSADO DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:4729 US HIGHWAY 98 S STE 201
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4336
Practice Address - Country:US
Practice Address - Phone:863-646-9663
Practice Address - Fax:863-646-9664
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN483208000000X, 208D00000X
PR17316208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN483OtherMEDICINE DOCTOR LIC