Provider Demographics
NPI:1497745129
Name:ROSARIO LEBRON, SANDRA E (MD, FCCP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:ROSARIO LEBRON
Suffix:
Gender:F
Credentials:MD, FCCP
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Other - Credentials:
Mailing Address - Street 1:EDIF CLINICA LAS AMERICAS OFIC 205
Mailing Address - Street 2:400 ROOSEVELT AVE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-765-1919
Mailing Address - Fax:787-763-4049
Practice Address - Street 1:EDIF CLINICA LAS AMERICAS OFIC 205
Practice Address - Street 2:400 ROOSEVELT AVE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-765-1919
Practice Address - Fax:787-763-4049
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12831174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG91074Medicare UPIN
PR90038Medicare ID - Type UnspecifiedPROVIDER NUMBER