Provider Demographics
NPI:1730467598
Name:RODRIGUEZ GINES, IDALISABEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IDALISABEL
Middle Name:
Last Name:RODRIGUEZ GINES
Suffix:
Gender:F
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:URB. VILLA CAROLINA
Mailing Address - Street 2:439 ST. BLOQ. 173-6
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-378-7670
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA CAMPO RICO ESQ. CALLE NUM. 7
Practice Address - Street 2:CALLE 8 BLOQUE 4 NUM.1 SABANA GARDENS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-762-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3942103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist