Provider Demographics
NPI:1033373303
Name:RODRIGUEZ, ISMAEL (MSW)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAGOS DEL NORTE 165
Mailing Address - Street 2:305
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-484-0452
Mailing Address - Fax:
Practice Address - Street 1:165 LAGOS DEL NORTE
Practice Address - Street 2:305
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-484-0452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR55441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5544OtherNUMERO DE LICENCIA DE TRABAJO SOCIAL