Provider Demographics
NPI:1831356468
Name:DE LEON, GWENDOLYN (MD)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3492 NW 82ND DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3575
Mailing Address - Country:US
Mailing Address - Phone:832-746-0309
Mailing Address - Fax:
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:SUITE400
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-918-7050
Practice Address - Fax:305-918-7051
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1243152086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery