Healthcare Provider Details

I. General information

NPI: 1962332262
Provider Name (Legal Business Name): REBECCA NICOHL LEBRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 60327
BAYAMON PR
00960-6032
US

IV. Provider business mailing address

I4 AVE SAN PATRICIO APT 2005
GUAYNABO PR
00968-3224
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-3001
  • Fax:
Mailing address:
  • Phone: 787-308-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: