Healthcare Provider Details

I. General information

NPI: 1528971140
Provider Name (Legal Business Name): LEEANGELA PEREZ CANDELARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 CALLE PAISAJE APT 202
PONCE PR
00716-4128
US

IV. Provider business mailing address

2931 CALLE PAISAJE APT 202 CONDOMINIO VILLA PANNONIA
PONCE PR
00716-4128
US

V. Phone/Fax

Practice location:
  • Phone: 939-429-1912
  • Fax:
Mailing address:
  • Phone: 939-429-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8007
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: