MEDICARE: DEBORA RODRIGUEZ MD

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	103TP2701X	Group Psychotherapy Psychologist	6561	PR

General Provider Information

NPI Number	:	1609471515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORA RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	1137 CALLE BOGOTA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-5362
Country	:	US
Telephone Number	:	787-644-3345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1137 CALLE BOGOTA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-5362
Country	:	US
Telephone Number	:	787-644-3345
Fax Number	:

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/15/2020

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