Provider Demographics
NPI:1538627138
Name:RENTAS LEON, LUIS ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANGEL
Last Name:RENTAS 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:URB. EL MADRIGAL CALLE 5 E-8
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00730
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:909 AVE TITO CASTRO STE 712
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4722
Practice Address - Country:US
Practice Address - Phone:787-813-0550
Practice Address - Fax:787-813-0555
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21255208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice