Provider Demographics
NPI:1972501963
Name:RONDA LEBRON, EDGARDO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:LUIS
Last Name:RONDA 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 1624
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1624
Mailing Address - Country:US
Mailing Address - Phone:787-739-7311
Mailing Address - Fax:787-739-7311
Practice Address - Street 1:CALLE FRANCISCO CRUZ HADDOCK URBANIZACIOU FERNANDEZ
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-7311
Practice Address - Fax:787-739-7311
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9424208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F60380Medicare UPIN
0081683Medicare ID - Type UnspecifiedSAN JUAN, PUERTO RICO