Individual
MODOMI J. ROMAN LEBRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
99 GUILLERMO RIEFKKOHL ST, PATILLAS, PR 00723-0072
(787) 839-4320
(787) 839-4320
Mailing address
99 GUILLERMO RIEFKOHL STREET, PATILLAS, PR 00723
(787) 839-4320
(787) 271-0004
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
007527
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196237
REGISTRY CERTIFICATE
PR
Enumeration date
08/18/2017
Last updated
06/16/2018
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