Healthcare Provider Details

I. General information

NPI: 1356463293
Provider Name (Legal Business Name): JOSE ANGEL LEDUC TEM PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CALLE 2 URB PH HERNANDEZ
RIO GRANDE PR
00745-3109
US

IV. Provider business mailing address

PO BOX 604
RIO GRANDE PR
00745-0604
US

V. Phone/Fax

Practice location:
  • Phone: 787-547-1203
  • Fax:
Mailing address:
  • Phone: 787-547-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number000922
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: