Provider Demographics
NPI:1184303083
Name:PERELES DE LEON, TOMAS ANDRE
Entity type:Individual
Prefix:
First Name:TOMAS
Middle Name:ANDRE
Last Name:PERELES DE LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 AVE ASHFORD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1230
Mailing Address - Country:US
Mailing Address - Phone:787-721-7895
Mailing Address - Fax:
Practice Address - Street 1:1130 AVE ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1230
Practice Address - Country:US
Practice Address - Phone:787-721-7895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR8173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program