Provider Demographics
NPI:1205064797
Name:RODRIGUEZ CRUZ, ALVIN JESUS (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:JESUS
Last Name:RODRIGUEZ CRUZ
Suffix:
Gender:M
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:HC 9 BOX 1658
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9713
Mailing Address - Country:US
Mailing Address - Phone:787-232-5060
Mailing Address - Fax:
Practice Address - Street 1:36 CALLE ESTRELLA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3832
Practice Address - Country:US
Practice Address - Phone:787-840-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical