Provider Demographics
NPI:1144285958
Name:DE LEON, NOEL S (MD, FACS)
Entity type:Individual
Prefix:MRS
First Name:NOEL
Middle Name:S
Last Name:DE LEON
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIMA PLAZA 1, SUITE 400
Mailing Address - Street 2:AVE. DEGETAU #500
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-961-4636
Mailing Address - Fax:787-653-3724
Practice Address - Street 1:PMB 644 1353, RD 19
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-691-4636
Practice Address - Fax:787-653-3724
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13359207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24161HMedicare ID - Type Unspecified
G69788Medicare UPIN