Healthcare Provider Details

I. General information

NPI: 1437061777
Provider Name (Legal Business Name): KRIZIA IVELISSE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL SANTA ROSA CARRETERA NUMERO DOS BLOQUE 51 59
BAYAMON PR
00969
US

IV. Provider business mailing address

URB VILLAS DE CANEY Q4A CALLE GUAJATACA
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-449-9262
  • Fax:
Mailing address:
  • Phone: 787-449-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8867
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: