MEDICARE: JOSE L LANDRON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	026101	PR

General Provider Information

NPI Number	:	1841263308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE L LANDRON RN

Provider Business Mailing Address
First Line	:	PO BOX 2382
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00694-2382
Country	:	US
Telephone Number	:	787-245-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVY RESERVE CENTER PUERTO RICO
Second Line	:	218 BROOK STREET
City	:	FT. BUCHANAN
State	:	PR
Zip	:	00934-4206
Country	:	US
Telephone Number	:	787-707-2332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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