Provider Demographics
NPI:1205976909
Name:DE LEON, MARISOL
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
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 1:8 CALLE PAZ
Mailing Address - Street 2:URB CAMPINA 2
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-7301
Mailing Address - Country:US
Mailing Address - Phone:787-226-0267
Mailing Address - Fax:
Practice Address - Street 1:8 CARR 31
Practice Address - Street 2:FRENTE GUARDIA NACIONAL
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3871
Practice Address - Country:US
Practice Address - Phone:787-734-7622
Practice Address - Fax:787-713-5692
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4455183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician