Provider Demographics
NPI:1205170834
Name:DELEON, DANIEL ALEJANDRO (DR)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEJANDRO
Last Name:DELEON
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2462
Mailing Address - Country:US
Mailing Address - Phone:305-860-6383
Mailing Address - Fax:305-860-6526
Practice Address - Street 1:2150 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2462
Practice Address - Country:US
Practice Address - Phone:305-860-6383
Practice Address - Fax:305-860-6526
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist