Provider Demographics
NPI:1679582118
Name:PIMENTEL - LEBRON, MANUEL O (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:O
Last Name:PIMENTEL - LEBRON
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 33385
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0385
Mailing Address - Country:US
Mailing Address - Phone:787-842-0062
Mailing Address - Fax:787-284-1397
Practice Address - Street 1:1 CALLE BERTOLY
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3758
Practice Address - Country:US
Practice Address - Phone:787-842-0062
Practice Address - Fax:787-284-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10109208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7330091OtherPROVIDER # HUMANA GOLD PL
PR063633OtherPROVIDER # CRUZ AZUL DE P
PR82341OtherPROVIDER # TRIPLE S PR
PR200038OtherPROVIDER # MMM HEALTHCARE
PR110109OtherPROVIDER # CIGNA OF PR
PR063633OtherPROVIDER # CRUZ AZUL DE P
PR0082341Medicare ID - Type UnspecifiedPROVIDER NUMBER