Provider Demographics
NPI:1043450729
Name:RODRIGUEZ, JANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANNETTE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CALLE REINA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9401
Mailing Address - Country:US
Mailing Address - Phone:787-438-9306
Mailing Address - Fax:787-883-3206
Practice Address - Street 1:117 CALLE REINA
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-9401
Practice Address - Country:US
Practice Address - Phone:787-438-9306
Practice Address - Fax:787-883-3206
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical