Provider Demographics
NPI:1801512843
Name:LEON JR, GILBERTO (ATS)
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:LEON JR
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4806
Mailing Address - Country:US
Mailing Address - Phone:224-276-9462
Mailing Address - Fax:
Practice Address - Street 1:610 4TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4806
Practice Address - Country:US
Practice Address - Phone:224-276-9462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer