Provider Demographics
NPI:1275957482
Name:MARCO A RODRIGUEZ APONTE PSC
Entity Type:Organization
Organization Name:MARCO A RODRIGUEZ APONTE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RODRIGUEZ APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-4668
Mailing Address - Street 1:P O BOX 1067
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-1067
Mailing Address - Country:US
Mailing Address - Phone:787-842-4668
Mailing Address - Fax:787-843-7161
Practice Address - Street 1:1326 CALLE SALUD
Practice Address - Street 2:EDIF EL SENORIAL, SUITE 305
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1686
Practice Address - Country:US
Practice Address - Phone:787-842-4668
Practice Address - Fax:787-843-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12385103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12385OtherLICENSE NUMBER
PR12385OtherLICENSE NUMBER