MEDICARE: DR. LUIS ANGEL RENTAS LEON MD

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
1	208D00000X	General Practice Physician	21255	PR

General Provider Information

NPI Number	:	1538627138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ANGEL RENTAS LEON MD

Provider Business Mailing Address
First Line	:	URB. EL MADRIGAL CALLE 5 E-8
Second Line	:
City	:	PONCE
State	:	PUERTO RICO
Zip	:	00730
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 AVE TITO CASTRO STE 712
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-4722
Country	:	US
Telephone Number	:	787-813-0550
Fax Number	:	787-813-0555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	07/15/2021

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