Provider Demographics
NPI:1356630362
Name:LEUTERIO, RAY PENA (PH D)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:PENA
Last Name:LEUTERIO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-1169
Mailing Address - Country:US
Mailing Address - Phone:928-283-1057
Mailing Address - Fax:928-283-1205
Practice Address - Street 1:67 FIR ST
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0067
Practice Address - Country:US
Practice Address - Phone:928-283-1161
Practice Address - Fax:928-283-1205
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4041953103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist