MEDICARE: MRS. AIDA RODRIGUEZ ROBLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1110	PR

General Provider Information

NPI Number	:	1336269786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AIDA RODRIGUEZ ROBLES

Provider Business Mailing Address
First Line	:	HC 9 BOX 3094
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00731-9753
Country	:	US
Telephone Number	:	787-217-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 AVE MUNOZ RIVERA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-0634
Country	:	US
Telephone Number	:	787-217-1611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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