Healthcare Provider Details

I. General information

NPI: 1578753661
Provider Name (Legal Business Name): ADA IRIS LEBRON SPL/AUD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. QUINTAS REALES D-3 C/ REINA ISABEL I
GUAYNABO PR
00969
US

IV. Provider business mailing address

PO BOX 70179
SAN JUAN PR
00936-8179
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-2222
  • Fax:
Mailing address:
  • Phone: 787-766-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number368
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number111
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: