Healthcare Provider Details

I. General information

NPI: 1124897764
Provider Name (Legal Business Name): LEONARDO GABRIEL NEGRON ROCHE BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 CALLE COQUI
ISABELA PR
00662-2138
US

IV. Provider business mailing address

PO BOX 941
ISABELA PR
00662-0941
US

V. Phone/Fax

Practice location:
  • Phone: 939-339-0016
  • Fax:
Mailing address:
  • Phone: 939-339-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number84366
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9695878
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number867588
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number84366
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: