Provider Demographics
NPI:1134322563
Name:LEAVITT- CARABALLO, JORGE LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:LEAVITT- CARABALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:URB SENDEROS DE MONTEHIEDRA
Mailing Address - Street 2:74 CALLE AGUAMARINA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-505-3750
Mailing Address - Fax:
Practice Address - Street 1:176 CALLE JOSE C VAZQUEZ BO CAONILLAS
Practice Address - Street 2:ANTIGUO HOSPIMEDICA
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3309
Practice Address - Country:US
Practice Address - Phone:787-337-9792
Practice Address - Fax:787-337-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17682207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037844900Medicaid
PR037844901Medicaid