Provider Demographics
NPI:1396336830
Name:CHARON, EDISON J (NL)
Entity type:Individual
Prefix:MR
First Name:EDISON
Middle Name:J
Last Name:CHARON
Suffix:
Gender:M
Credentials:NL
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:CALLE BALBINO TRINTA URB. RIO CRISTAL #9244
Mailing Address - Street 2:CALLE BALBINO TRINTA URB. RIO CRISTAL #9244
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-605-5305
Mailing Address - Fax:
Practice Address - Street 1:CALLE BALBINO TRINTA URB. RIO CRISTAL #9244
Practice Address - Street 2:CALLE BALBINO TRINTA URB. RIO CRISTAL #9244
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-605-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR195175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath