Provider Demographics
NPI:1497171359
Name:HURTADO PONCE DE LEON, SANDRA ELENA
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELENA
Last Name:HURTADO PONCE DE LEON
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:MIRAMAR EMBASSY 902
Mailing Address - Street 2:PONCE DE LEON AVE. APT 306
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-533-3390
Mailing Address - Fax:
Practice Address - Street 1:COND MIRAMAR # 902
Practice Address - Street 2:PONCE DE LEON AVE. APT 306
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3458
Practice Address - Country:US
Practice Address - Phone:787-533-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2110780172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver