Healthcare Provider Details

I. General information

NPI: 1396336830
Provider Name (Legal Business Name): EDISON J CHARON NL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BALBINO TRINTA URB. RIO CRISTAL #9244 CALLE BALBINO TRINTA URB. RIO CRISTAL #9244
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

CALLE BALBINO TRINTA URB. RIO CRISTAL #9244 CALLE BALBINO TRINTA URB. RIO CRISTAL #9244
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-605-5305
  • Fax:
Mailing address:
  • Phone: 787-605-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number195
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: