Provider Demographics
NPI:1194755546
Name:LEBRON, MARIBEL (MD)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:LEBRON
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:PO BOX 192561
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2561
Mailing Address - Country:US
Mailing Address - Phone:787-764-7733
Mailing Address - Fax:
Practice Address - Street 1:SUITE 606 LA TORRE DE PLAZA
Practice Address - Street 2:PLAZA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8058
Practice Address - Country:US
Practice Address - Phone:787-764-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG73641Medicare UPIN
PR89744Medicare ID - Type Unspecified