Provider Demographics
NPI:1770058554
Name:RODRIGUEZ CORTES, CARLA NICOLE (MA)
Entity type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:NICOLE
Last Name:RODRIGUEZ CORTES
Suffix:
Gender:F
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:E10 CALLE CERRO PIO
Mailing Address - Street 2:LOMAS DE CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-0000
Mailing Address - Country:US
Mailing Address - Phone:787-396-1145
Mailing Address - Fax:
Practice Address - Street 1:E10 CALLE CERRO PIO
Practice Address - Street 2:LOMAS DE CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-0000
Practice Address - Country:US
Practice Address - Phone:787-396-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6127103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist