Provider Demographics
NPI:1437822848
Name:RODRIGUEZ SOTO, JOSUE RAUL (LIC)
Entity Type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:RAUL
Last Name:RODRIGUEZ SOTO
Suffix:
Gender:M
Credentials:LIC
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 2598 JUNCAL CONTRACT STATION
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-3001
Mailing Address - Country:US
Mailing Address - Phone:787-552-7991
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MONTALVO #119 BO. MARAVILLA NORTE
Practice Address - Street 2:
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670
Practice Address - Country:US
Practice Address - Phone:787-827-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR148711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty