Provider Demographics
NPI:1710183082
Name:RODRIGUEZ COLON, SOFIA
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:RODRIGUEZ COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:
Other - Last Name:RODRIGUEZ COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DRA
Mailing Address - Street 1:HC 8 BOX 45176
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9755
Mailing Address - Country:US
Mailing Address - Phone:939-438-5614
Mailing Address - Fax:
Practice Address - Street 1:CARR. 110 KM 22.5 BO CEIBA BAJA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-413-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6126103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058973Medicare PIN