1255507729 NPI number — MISS CLARY M LEON ATOL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255507729 NPI number — MISS CLARY M LEON ATOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEON
Provider First Name:
CLARY
Provider Middle Name:
M
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ATOL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEON
Provider Other First Name:
CLARY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
THL
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255507729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 2 BOX 3934
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00707-9867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-638-9734
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA # 3 INT 759 KM 2 HM 4 BARRIO LIZAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-638-9734
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  689 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2355S0801X , with the licence number: 1024 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)