Provider Demographics
NPI:1396599940
Name:DE LEON, GERARDO
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:DE 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 1:9101 W OKEECHOBEE RD STE 205A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2116
Mailing Address - Country:US
Mailing Address - Phone:645-201-8281
Mailing Address - Fax:
Practice Address - Street 1:9101 W OKEECHOBEE RD STE 205A
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2116
Practice Address - Country:US
Practice Address - Phone:645-201-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy