Healthcare Provider Details

I. General information

NPI: 1659413763
Provider Name (Legal Business Name): MONICA M LEBRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 1 BO TURABO LOCAL C31C CONSOLIDATED MALL PMB 565 BOX 4952
CAGUAS PR
00725
US

IV. Provider business mailing address

BOX 4952 SUITE 565
CAGUAS PR
00726-4952
US

V. Phone/Fax

Practice location:
  • Phone: 787-286-1694
  • Fax:
Mailing address:
  • Phone: 787-745-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4518
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: