Healthcare Provider Details

I. General information

NPI: 1881622942
Provider Name (Legal Business Name): LELIS L. NAZARIO-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UPR MEDICAL SCIENCES CAMPUS, SCHOOL OF MEDICINE DEPT. OF PSYCHIATRY, 9TH FLOOR, OFFICE A-994
SAN JUAN PR
00935
US

IV. Provider business mailing address

UPR MEDICAL SCIENCES CAMPUS, SCHOOL OF MEDICINE DEPT. OF PSYCHIATRY, PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-765-4047
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-765-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11679
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number11679
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: