Healthcare Provider Details

I. General information

NPI: 1851695241
Provider Name (Legal Business Name): JOSE A. DE LEON Y ASOCIADOS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE FLOR GERENA N
HUMACAO PR
00791-4288
US

IV. Provider business mailing address

PO BOX 715
JUNCOS PR
00777-0715
US

V. Phone/Fax

Practice location:
  • Phone: 787-202-8547
  • Fax:
Mailing address:
  • Phone: 787-202-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1311
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1311
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1311
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE A DE LEON
Title or Position: PSICOLOGO CLINICO
Credential: PHD.
Phone: 787-207-8547