Provider Demographics
NPI:1104406768
Name:LEON, GABRIEL A SR
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:A
Last Name:LEON
Suffix:SR
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 1:6467 PARK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3980
Mailing Address - Country:US
Mailing Address - Phone:504-331-2938
Mailing Address - Fax:
Practice Address - Street 1:6467 PARK MANOR DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-3980
Practice Address - Country:US
Practice Address - Phone:504-331-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8366249172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty