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NPI Code Detail

MEDICARE: DR. TERESITA DE LEON M.D.

MEDICARE: DR. TERESITA DE LEON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist13221PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120352OTHERPRTRIPLE S

General Provider Information

NPI Number : 1063728020
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESITA DE LEON M.D.
Provider Business Mailing Address
First Line : AVE PONCE DE LEON
Second Line : #1507 SUITE IC
City : SAN JUAN
State : PR
Zip : 00915-3959
Country : US
Telephone Number : 787-721-3722
Fax Number : 787-723-6866
Provider Business Practice Location Address
First Line : AVE PONCE DE LEON
Second Line : #1507 SUITE IC
City : SAN JUAN
State : PR
Zip : 00915-3959
Country : US
Telephone Number : 787-721-3722
Fax Number : 787-723-6866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2010
Last Update Date : 08/27/2010

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Directions to “ DR. TERESITA DE LEON M.D.” Practice Location

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