Provider Demographics
NPI:1073523734
Name:RODRIGUEZ, RAMON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9616
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9616
Mailing Address - Country:US
Mailing Address - Phone:787-641-7582
Mailing Address - Fax:787-622-4526
Practice Address - Street 1:VAMC 10 CASIA STREET
Practice Address - Street 2:GERIATRICS (11C)
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-622-4526
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical