Healthcare Provider Details

I. General information

NPI: 1245120518
Provider Name (Legal Business Name): BIANCA PAOLA CARDONA LEBRON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 CALLE PAVIA FERNANDEZ
SAN SEBASTIAN PR
00685-2207
US

IV. Provider business mailing address

HC 4 BOX 40142
SAN SEBASTIAN PR
00685-8515
US

V. Phone/Fax

Practice location:
  • Phone: 787-920-1310
  • Fax:
Mailing address:
  • Phone: 787-354-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number8358
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8358
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: