Provider Demographics
NPI:1114580255
Name:GONZALEZ MENENDEZ, LEANABEL DALIZ
Entity Type:Individual
Prefix:MISS
First Name:LEANABEL
Middle Name:DALIZ
Last Name:GONZALEZ MENENDEZ
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:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0662
Mailing Address - Country:US
Mailing Address - Phone:939-969-1382
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MONACILLOS AVE GOBERNADOR PINERO
Practice Address - Street 2:CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-480-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program