Provider Demographics
NPI:1154744142
Name:CRUZ LEON, ROY GERARDO
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:GERARDO
Last Name:CRUZ LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB OLYMPIC VILLE CALLE SYDNEY BUZON 96
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00771
Mailing Address - Country:UM
Mailing Address - Phone:939-325-3255
Mailing Address - Fax:
Practice Address - Street 1:HC 45 BOX 13846
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-9779
Practice Address - Country:US
Practice Address - Phone:939-325-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist