Provider Demographics
NPI:1669142972
Name:RODRIGUEZ, LAURA CRISTINA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CRISTINA
Last Name:RODRIGUEZ
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:LES JARDINS
Mailing Address - Street 2:150 CONECTOR C APT 332
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2277
Mailing Address - Country:US
Mailing Address - Phone:787-206-8711
Mailing Address - Fax:
Practice Address - Street 1:PP-14 CALLE 5
Practice Address - Street 2:URB CANA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-206-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7060103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool