Individual
ENID DE LEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4642 WYDHAM LN, ORLANDO, FL 32812-8068
(407) 360-4703
Mailing address
4642 WYDHAM LN, ORLANDO, FL 32812-8068
(407) 360-4703
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
12/05/2016
Last updated
12/05/2016
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