Healthcare Provider Details

I. General information

NPI: 1184544074
Provider Name (Legal Business Name): CRISTINA NICOLE LEON LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 BO DULCES LABIOS CALLE RAMON BAYRON
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

62 BO DULCES LABIOS CALLE RAMON BAYRON
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 787-410-4955
  • Fax:
Mailing address:
  • Phone: 787-410-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8753
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: