=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952982571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEANDRA PAULINA GARCIA JORGE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2021
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | THE FALLS 2 CARR 177 APT 515 L8
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-710-5404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | THE FALLS 2 CARR 177 APT 515 L8
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-710-5404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 003411
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------