Provider Demographics
NPI:1942225701
Name:GARCIA ESCANELLE, LEONOR M (MD)
Entity Type:Individual
Prefix:MRS
First Name:LEONOR
Middle Name:M
Last Name:GARCIA ESCANELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:330 CALLE 11 NE
Mailing Address - Street 2:PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2418
Mailing Address - Country:US
Mailing Address - Phone:787-203-0832
Mailing Address - Fax:
Practice Address - Street 1:RR 1 12 ST SUITE 3
Practice Address - Street 2:URB CANA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-946-9500
Practice Address - Fax:787-946-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14563208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16797Medicare UPIN
PR0021554Medicare PIN