Healthcare Provider Details

I. General information

NPI: 1952982571
Provider Name (Legal Business Name): LEANDRA PAULINA GARCIA JORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE FALLS 2 CARR 177 APT 515 L8
GUAYNABO PR
00966
US

IV. Provider business mailing address

THE FALLS 2 CARR 177 APT 515 L8
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-710-5404
  • Fax:
Mailing address:
  • Phone: 787-710-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number003411
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: