Provider Demographics
NPI:1396298758
Name:RODRIGUEZ PEREZ, EDWIN (MA)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:RODRIGUEZ PEREZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H10 CALLE ALBORADA
Mailing Address - Street 2:BO. CASTILLO
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1331
Mailing Address - Country:US
Mailing Address - Phone:787-923-6127
Mailing Address - Fax:
Practice Address - Street 1:H10 CALLE ALBORADA
Practice Address - Street 2:BO. CASTILLO
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1331
Practice Address - Country:US
Practice Address - Phone:787-923-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5722103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool