Provider Demographics
NPI:1245399708
Name:LEON MATHEU, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:LEON MATHEU
Suffix:
Gender:M
Credentials:MD
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 194181
Mailing Address - Street 2:HATO REY STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-763-8902
Mailing Address - Fax:787-765-5105
Practice Address - Street 1:CALLE GARCIA MORNO ESQ VALLEJO
Practice Address - Street 2:PUBLIC HEALTH UNIT EDIFICIO 1155
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-763-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6299208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics