Provider Demographics
NPI:1669773388
Name:RODRIGUEZ GARCIA, JAVIER ENRIQUE (PSY D)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:ENRIQUE
Last Name:RODRIGUEZ GARCIA
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 149 BARRIO JAGUAS
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-0366
Mailing Address - Country:US
Mailing Address - Phone:787-391-2890
Mailing Address - Fax:
Practice Address - Street 1:CARR 149 BO. ARRIBA SALIENTE
Practice Address - Street 2:BO. RIO ARRIBA SALIENTE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-391-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR202020Medicaid
PR202020Medicaid
PR202020Medicare Oscar/Certification
202020Medicare PIN