Provider Demographics
NPI:1275752149
Name:ROSARIO SANJURJO, LEXTER I (PHD)
Entity Type:Individual
Prefix:MR
First Name:LEXTER
Middle Name:
Last Name:ROSARIO SANJURJO
Suffix:I
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:LEXTER
Other - Middle Name:
Other - Last Name:ROSARIO
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:721 CALLE HERNANDEZ
Mailing Address - Street 2:COND. MIRAMAR TOWERS APT 12-C
Mailing Address - City:SAN JAUN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-310-2604
Mailing Address - Fax:787-876-2003
Practice Address - Street 1:CARR. 188-JNT 187 LOIZA
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-2042
Practice Address - Fax:787-876-2003
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PR2363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2363OtherPSYCHOLOGIST PROFESSIONAL
PR2363OtherPSYCHOLOGY