Provider Demographics
NPI:1114156882
Name:DE LEON, JUAN BAUTISTA RIVERA (LND)
Entity Type:Individual
Prefix:MR
First Name:JUAN BAUTISTA
Middle Name:RIVERA
Last Name:DE LEON
Suffix:
Gender:M
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SAN ISIDRO CALLE CALIXTO CARRERA
Mailing Address - Street 2:#73
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-2029
Mailing Address - Country:US
Mailing Address - Phone:787-643-0494
Mailing Address - Fax:
Practice Address - Street 1:SAN ISIDRO CALLE CALIXTO CARRERA
Practice Address - Street 2:#73
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-2029
Practice Address - Country:US
Practice Address - Phone:787-643-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1385133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education