Provider Demographics
NPI:1114509536
Name:RODRIGUEZ AGOSTO, JOSE EFRAIN (MA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EFRAIN
Last Name:RODRIGUEZ AGOSTO
Suffix:
Gender:M
Credentials:MA
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 3327
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3327
Mailing Address - Country:US
Mailing Address - Phone:787-307-9339
Mailing Address - Fax:
Practice Address - Street 1:31 CALLE 1
Practice Address - Street 2:URB. MONTECIELO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-307-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6695OtherPSYCHOLOGIST