Provider Demographics
NPI:1306327473
Name:DE LEON, VICTOR AMAURY (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:AMAURY
Last Name:DE LEON
Suffix:
Gender:M
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:BC19 CALLE RIO AMAZONAS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3271
Mailing Address - Country:US
Mailing Address - Phone:787-308-9559
Mailing Address - Fax:
Practice Address - Street 1:BC19 RIO AMAZONAS ST
Practice Address - Street 2:VALLE VERDE 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-308-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35207390200000X
PR24065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR550658202OtherPASSPORT