Provider Demographics
NPI:1073385514
Name:ESTRELLA RODRIGUEZ, PRISCILA MARIE
Entity Type:Individual
Prefix:
First Name:PRISCILA
Middle Name:MARIE
Last Name:ESTRELLA RODRIGUEZ
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 1:748 CALLE ESTACION
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-2601
Mailing Address - Country:US
Mailing Address - Phone:787-372-0541
Mailing Address - Fax:
Practice Address - Street 1:748 CALLE ESTACION
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-2601
Practice Address - Country:US
Practice Address - Phone:787-372-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist