Provider Demographics
NPI:1578370466
Name:LEON GUZMAN, RUBEN SR (PSYD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:LEON GUZMAN
Suffix:SR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VALLE SERENO #32 CALLE AMOR
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9324
Mailing Address - Country:US
Mailing Address - Phone:787-432-6433
Mailing Address - Fax:
Practice Address - Street 1:EXECUTIVE HALL 471 SUITE 103A
Practice Address - Street 2:CALLE FERROCARRIL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-4199
Practice Address - Country:US
Practice Address - Phone:787-432-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical