Individual
LESLIE A WAGENBERG-GRELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 MEDICAL BLVD, SUITE 106, SPRING HILL, FL 34609-0220
(352) 684-1340
(352) 684-0694
Mailing address
120 MEDICAL BLVD, SUITE 106, SPRING HILL, FL 34609-0220
(352) 684-1340
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME 110500
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006606100
—
FL
Enumeration date
09/27/2011
Last updated
09/14/2020
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