Provider Demographics
NPI:1568682631
Name:RODRIGUEZ, MYRNA IRIS (PHD)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:IRIS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:5009 PASEO CONSTANCIA
Mailing Address - Street 2:HACIENDAS DEL MONTE
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2372
Mailing Address - Country:US
Mailing Address - Phone:787-848-1002
Mailing Address - Fax:787-844-9019
Practice Address - Street 1:8129 CALLE CONCORDIA
Practice Address - Street 2:CONDO. CONCORDIA SUITE502
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1548
Practice Address - Country:US
Practice Address - Phone:787-844-0125
Practice Address - Fax:787-844-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical