Provider Demographics
NPI:1235606260
Name:RODRIGUEZ ORTIZ, LUIS DANIEL (MC; MHC; LPC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:DANIEL
Last Name:RODRIGUEZ ORTIZ
Suffix:
Gender:M
Credentials:MC; MHC; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE HORTENSIA COND SKY TOWER II APT 16F
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:939-235-9477
Mailing Address - Fax:
Practice Address - Street 1:J9 CALLE 2
Practice Address - Street 2:EXTENSION HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-622-5420
Practice Address - Fax:787-622-5430
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4345101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor