Provider Demographics
NPI:1528575008
Name:ALICEA RODRIGUEZ, HECTOR RUBEN (PSYMA)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:RUBEN
Last Name:ALICEA RODRIGUEZ
Suffix:
Gender:M
Credentials:PSYMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B2 CALLE BOLIVIA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3464
Mailing Address - Country:US
Mailing Address - Phone:787-462-5032
Mailing Address - Fax:
Practice Address - Street 1:B2 CALLE BOLIVIA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3464
Practice Address - Country:US
Practice Address - Phone:787-462-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR299103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent