Healthcare Provider Details

I. General information

NPI: 1497714299
Provider Name (Legal Business Name): ANNETTE V LEON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 AVE ASHFORD
SAN JUAN PR
00907-1511
US

IV. Provider business mailing address

PO BOX 11913
SAN JUAN PR
00922-1913
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-2160
  • Fax:
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-841-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number9605
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: