Basic Information
| Provider Information | |||||||||
| NPI: | 1023182052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSARIO-LEON | ||||||||
| FirstName: | NELSON | ||||||||
| MiddleName: | RICARDO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 W. ST. MARY'S RD | ||||||||
| Address2: | UNIT 2 NORTH ST. MARY'S HOSPITAL | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208724910 | ||||||||
| FaxNumber: | 5208725495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 W. ST. MARY'S RD | ||||||||
| Address2: | UNIT 2 NORTH ST. MARY'S HOSPITAL | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208724910 | ||||||||
| FaxNumber: | 5208725495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 21526 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 430736 | 05 | AZ | MEDICAID |