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General NPI Number Information
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NPI Number | 1104586783
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Entity Type | Individual
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Provider Name | JESSICA R LEBRON MHSN, RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 715 AVE PONCE DE LEON
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City | HATO REY
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State | PR
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Zip | 00917-5032
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Country | US
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Telephone | 787-758-2000
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Fax |
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Provider Business Mailing Address
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Address Line | URB VILLA CONTESSA F24 CALLE ARAGON
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City | BAYAMON
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State | PR
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Zip | 00956-2778
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Country | US
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Telephone | 469-449-3634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 002192
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License Number State | PR
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