Provider Demographics
NPI:1891229134
Name:RODRIGUEZ HERNANDEZ, NIVIA ISABEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NIVIA
Middle Name:ISABEL
Last Name:RODRIGUEZ HERNANDEZ
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:PO BOX 800558
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0558
Mailing Address - Country:US
Mailing Address - Phone:787-385-8020
Mailing Address - Fax:
Practice Address - Street 1:1805 URB CONSTANCIA
Practice Address - Street 2:PASEO LA COLONIA STE. 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0000
Practice Address - Country:US
Practice Address - Phone:787-651-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5865103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical