Provider Demographics
NPI:1871125344
Name:DE LEON ALAGO, CHEJARA
Entity type:Individual
Prefix:
First Name:CHEJARA
Middle Name:
Last Name:DE LEON ALAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BOSQUE DE LOS PINOS
Mailing Address - Street 2:354 CALLE PALUSTRIS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-439-5582
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA MUNOZ RIVERA
Practice Address - Street 2:#425- NG
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-221-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR218174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator