Provider Demographics
NPI:1457892440
Name:DE LEON-RODRIGUEZ, TATIANA M (PHD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:M
Last Name:DE LEON-RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C5 CALLE 2
Mailing Address - Street 2:VILLAS DEL PILAR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-644-4120
Mailing Address - Fax:
Practice Address - Street 1:C5 CALLE 2
Practice Address - Street 2:VILLAS DEL PILAR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-644-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical