Provider Demographics
NPI:1568679637
Name:RODRIGUEZ, EDUARDO ANDRES (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:ANDRES
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CALLE VILLAMIL
Mailing Address - Street 2:CONDADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1813
Mailing Address - Country:US
Mailing Address - Phone:787-724-1704
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL PAVILLION SUITE NO. 4
Practice Address - Street 2:PARADA 20 SAN RAFAEL 1396
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-725-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical