Provider Demographics
NPI:1891201323
Name:LEON, RAUL
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13228 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2247
Mailing Address - Country:US
Mailing Address - Phone:786-201-4296
Mailing Address - Fax:
Practice Address - Street 1:1501 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5559
Practice Address - Country:US
Practice Address - Phone:786-378-8200
Practice Address - Fax:305-907-5871
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9287516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily