Provider Demographics
NPI:1023182052
Name:ROSARIO-LEON, NELSON RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:RICARDO
Last Name:ROSARIO-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 1:1601 W. ST. MARY'S RD
Mailing Address - Street 2:UNIT 2 NORTH ST. MARY'S HOSPITAL
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85795
Mailing Address - Country:US
Mailing Address - Phone:520-872-4910
Mailing Address - Fax:520-872-5495
Practice Address - Street 1:1601 W. ST. MARY'S RD
Practice Address - Street 2:UNIT 2 NORTH ST. MARY'S HOSPITAL
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85795
Practice Address - Country:US
Practice Address - Phone:520-872-4910
Practice Address - Fax:520-872-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ215262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430736Medicaid
B42029Medicare UPIN
AZ430736Medicaid