Provider Demographics
NPI:1316076789
Name:RESTO LEON, IVETTE (MD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:RESTO 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:PMB 854
Mailing Address - Street 2:138 AVE WINSTON CHURCHILL URB CROWN HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0613
Mailing Address - Country:US
Mailing Address - Phone:787-547-4790
Mailing Address - Fax:787-759-0101
Practice Address - Street 1:550 SERGIO CUEVAS BUSTAMANTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-547-4790
Practice Address - Fax:787-759-0101
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15306207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology