Provider Demographics
NPI:1689905192
Name:RODRIGUEZ RAMOS, EDUARDO LUIS (PSYD)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:LUIS
Last Name:RODRIGUEZ RAMOS
Suffix:
Gender:M
Credentials:PSYD
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 3409
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-0409
Mailing Address - Country:US
Mailing Address - Phone:787-462-4077
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO TOMAS KUILAND 2DO PISO SUITE 15 CARR 167
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0000
Practice Address - Country:US
Practice Address - Phone:787-462-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3660174400000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No174400000XOther Service ProvidersSpecialist