Healthcare Provider Details

I. General information

NPI: 1588588024
Provider Name (Legal Business Name): AWILDA LEON PSICOLOGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE MEJICO
SAN JUAN PR
00917-2613
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX # 471
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-642-9855
  • Fax:
Mailing address:
  • Phone: 787-642-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number009061
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: