Provider Demographics
NPI:1750402475
Name:REINALDO LEBRON
Entity type:Organization
Organization Name:REINALDO LEBRON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-453-7440
Mailing Address - Street 1:HC 1 BOX 6397
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-9616
Mailing Address - Country:US
Mailing Address - Phone:787-453-7440
Mailing Address - Fax:
Practice Address - Street 1:PARCELAS 256
Practice Address - Street 2:BOX YAUREL SECTOR SANTA CLARA
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-453-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 3553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057372Medicare ID - Type UnspecifiedAMBULANCE LAND