MEDICARE: DR. EDGARDO LUIS RONDA LEBRON 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	9424	PR

General Provider Information

NPI Number	:	1972501963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGARDO LUIS RONDA LEBRON MD

Provider Business Mailing Address
First Line	:	PO BOX 1624
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739-1624
Country	:	US
Telephone Number	:	787-739-7311
Fax Number	:	787-739-7311

Provider Business Practice Location Address
First Line	:	CALLE FRANCISCO CRUZ HADDOCK URBANIZACIOU FERNANDEZ
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739
Country	:	US
Telephone Number	:	787-739-7311
Fax Number	:	787-739-7311

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/01/2012

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