Provider Demographics
NPI:1366653990
Name:LEBRON, RAQUEL
Entity Type:Individual
Prefix:
First Name:RAQUEL
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:BO.VALENCIANO
Mailing Address - Street 2:BOX 574
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-736-5654
Mailing Address - Fax:
Practice Address - Street 1:BO.VALENCIANO
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-0574
Practice Address - Country:US
Practice Address - Phone:787-736-5654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR628224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant