Provider Demographics
NPI:1881376028
Name:DE LEON RODRIGUEZ, DAMIAN SR (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:
Last Name:DE LEON RODRIGUEZ
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:HC 4 BOX 4400
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9524
Mailing Address - Country:US
Mailing Address - Phone:787-506-2899
Mailing Address - Fax:
Practice Address - Street 1:673 CALLE ESCOLASTICO LOPEZ
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2834
Practice Address - Country:US
Practice Address - Phone:787-719-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty