Provider Demographics
NPI:1619680428
Name:RODRIGUEZ GONZALEZ, NAIXA MARI (MS)
Entity Type:Individual
Prefix:
First Name:NAIXA
Middle Name:MARI
Last Name:RODRIGUEZ GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 PRADERAS DEL RIO FLORES
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-2642
Mailing Address - Country:US
Mailing Address - Phone:787-934-7541
Mailing Address - Fax:
Practice Address - Street 1:CAPITAN II, PR-2 KM 1.59 AVENIDA HOSTOS,
Practice Address - Street 2:828 VILLA ZORAIDA SUITE 202
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:939-499-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist