Provider Demographics
NPI:1063728020
Name:DE LEON, TERESITA (MD)
Entity type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:
Last Name:DE LEON
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:AVE PONCE DE LEON
Mailing Address - Street 2:#1507 SUITE IC
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3959
Mailing Address - Country:US
Mailing Address - Phone:787-721-3722
Mailing Address - Fax:787-723-6866
Practice Address - Street 1:AVE PONCE DE LEON
Practice Address - Street 2:#1507 SUITE IC
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3959
Practice Address - Country:US
Practice Address - Phone:787-721-3722
Practice Address - Fax:787-723-6866
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20352OtherTRIPLE S