Provider Demographics
NPI:1588281984
Name:LEON TORRES, FAVIOLA JO ANN
Entity type:Individual
Prefix:
First Name:FAVIOLA
Middle Name:JO ANN
Last Name:LEON TORRES
Suffix:
Gender:F
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. VILLA UNIVERSITARIA, C-53, CALLE ROIG
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL GENERAL CASTANER
Practice Address - Street 2:
Practice Address - City:CASTANER
Practice Address - State:PR
Practice Address - Zip Code:00631
Practice Address - Country:US
Practice Address - Phone:787-829-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7181103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist