Provider Demographics
NPI:1659097152
Name:RODRIGUEZ LEON, CAMELIA
Entity Type:Individual
Prefix:
First Name:CAMELIA
Middle Name:
Last Name:RODRIGUEZ LEON
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 1:065 CALLE CAMPINA
Mailing Address - Street 2:PASEO DEL PRADO
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7603
Mailing Address - Country:US
Mailing Address - Phone:939-940-1262
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 8860 KM 1.5
Practice Address - Street 2:PLAZA MATIENZO SHOPPING CENTER SEGUNDO NIVEL SUITE 3
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-550-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool