Provider Demographics
NPI:1699409722
Name:RODRIGUEZ-VAZQUEZ, ANA VICTORIA (CSW)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:VICTORIA
Last Name:RODRIGUEZ-VAZQUEZ
Suffix:
Gender:F
Credentials:CSW
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 478
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0478
Mailing Address - Country:US
Mailing Address - Phone:939-247-2769
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 818 NORTE, KM 2 HM 7, SECTOR LA ESCUELITA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0078
Practice Address - Country:US
Practice Address - Phone:939-247-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2501021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty