Healthcare Provider Details

I. General information

NPI: 1457277675
Provider Name (Legal Business Name): MRS. MARISANDRA LEBRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

L30 CALLE 7
YABUCOA PR
00767-3037
US

IV. Provider business mailing address

L30 CALLE 7
YABUCOA PR
00767-3037
US

V. Phone/Fax

Practice location:
  • Phone: 787-349-2601
  • Fax:
Mailing address:
  • Phone: 787-892-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number553
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: