Provider Demographics
NPI:1730646381
Name:RODRIGUEZ DE JESUS, MARISEL
Entity Type:Individual
Prefix:
First Name:MARISEL
Middle Name:
Last Name:RODRIGUEZ DE JESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CELIS AGUILERA SUITE 5 EDIFICIO PLAZA DEL PARQUE
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:939-257-3471
Mailing Address - Fax:
Practice Address - Street 1:60 CELIS AGUILERA SUITE 5 EDIFICIO PLAZA DEL PARQUE
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:393-257-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR114381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical