Provider Demographics
NPI:1033646450
Name:LEBRON, EVIDALIA
Entity Type:Individual
Prefix:
First Name:EVIDALIA
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 URB RAHOLISA GDNS
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2415
Mailing Address - Country:US
Mailing Address - Phone:787-896-2080
Mailing Address - Fax:787-896-6615
Practice Address - Street 1:3 URB RAHOLISA GDNS
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2415
Practice Address - Country:US
Practice Address - Phone:787-896-2080
Practice Address - Fax:787-896-6615
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist