Provider Demographics
NPI:1225450828
Name:RODRIGUEZ, YAMINET (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YAMINET
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:YAMINET
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 STREET J25 FAIRVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-8123
Mailing Address - Country:US
Mailing Address - Phone:787-949-3205
Mailing Address - Fax:
Practice Address - Street 1:FAIRVIEW
Practice Address - Street 2:J25 16 STREET
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-8123
Practice Address - Country:US
Practice Address - Phone:787-949-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5568103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist