Healthcare Provider Details

I. General information

NPI: 1679936876
Provider Name (Legal Business Name): JUAN GERARDO RODRIGUEZ LCDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 5 BOX 8706
BAYAMON PR
00956-9727
US

IV. Provider business mailing address

RR 5 BOX 8706
BAYAMON PR
00956-9727
US

V. Phone/Fax

Practice location:
  • Phone: 787-428-1218
  • Fax:
Mailing address:
  • Phone: 787-428-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4149
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4149
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: