Healthcare Provider Details

I. General information

NPI: 1871125344
Provider Name (Legal Business Name): CHEJARA DE LEON ALAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA MUNOZ RIVERA #425- NG
SAN JUAN PR
00918
US

IV. Provider business mailing address

URB BOSQUE DE LOS PINOS 354 CALLE PALUSTRIS
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-221-3623
  • Fax:
Mailing address:
  • Phone: 787-439-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number218
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: