Provider Demographics
NPI:1861431900
Name:DE LEON, MARIDOLORES (MD)
Entity type:Individual
Prefix:DR
First Name:MARIDOLORES
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARI
Other - Middle Name:D
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:D21 CALLE C
Mailing Address - Street 2:EL DORADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3481
Mailing Address - Country:US
Mailing Address - Phone:787-765-3909
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13184207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine