Provider Demographics
NPI:1730641549
Name:DE LEON, MARIA VIRGEN
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VIRGEN
Last Name: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:J15 CALLE CAOBA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4720
Mailing Address - Country:US
Mailing Address - Phone:787-402-0861
Mailing Address - Fax:
Practice Address - Street 1:J15 CALLE CAOBA
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4720
Practice Address - Country:US
Practice Address - Phone:787-402-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1854280OtherDRIVER LICENSE