Provider Demographics
NPI:1346482353
Name:RODRIGUEZ, SHATSEI V
Entity Type:Individual
Prefix:
First Name:SHATSEI
Middle Name:V
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:BOX 375106
Mailing Address - Street 2:CUC STATION
Mailing Address - City:CAYEY
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00737
Mailing Address - Country:UM
Mailing Address - Phone:787-602-1124
Mailing Address - Fax:787-471-0011
Practice Address - Street 1:BOX 375106
Practice Address - Street 2:CUC STATION
Practice Address - City:CAYEY
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00737
Practice Address - Country:UM
Practice Address - Phone:787-602-1124
Practice Address - Fax:787-471-0011
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical