Provider Demographics
NPI:1063614774
Name:DE LEON TELLADO, NICOLLE FRANCHESCA (MD)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:FRANCHESCA
Last Name:DE LEON TELLADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 CARR 21
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3399
Mailing Address - Country:US
Mailing Address - Phone:787-782-9999
Mailing Address - Fax:
Practice Address - Street 1:1781 CARR 21
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3303
Practice Address - Country:US
Practice Address - Phone:787-782-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17091390200000X, 208D00000X
AL350462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice