1942957634 NPI number — MIOSOTIS DE LEON LIC

Table of content: MIOSOTIS DE LEON LIC (NPI 1942957634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942957634 NPI number — MIOSOTIS DE LEON LIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LEON
Provider First Name:
MIOSOTIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LIC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LEON
Provider Other First Name:
MIOSOTIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
TS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1942957634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE SILVIA REXACH
Provider Second Line Business Mailing Address:
URB ESTANCIAS DEL ROCIO 492
Provider Business Mailing Address City Name:
LAS PIEDRAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-210-5016
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO GUARAGUAO
Provider Second Line Business Practice Location Address:
CARR 833 KM 1.0
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-222-3395
Provider Business Practice Location Address Fax Number:
787-222-3395
Provider Enumeration Date:
03/03/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  15529 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)