Provider Demographics
NPI:1083161418
Name:RODRIGUEZ, ROSA DEL MAR
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:DEL MAR
Last Name: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 1:609 CALLE CUEVILLAS APARTMENT 8A
Mailing Address - Street 2:MIRAMAR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-320-3733
Mailing Address - Fax:
Practice Address - Street 1:1607 PONCE DE LEON AVE
Practice Address - Street 2:COBIAN'S PLAZA BUILDING SUITE 305
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00940
Practice Address - Country:US
Practice Address - Phone:787-320-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005564103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist