Healthcare Provider Details

I. General information

NPI: 1336532431
Provider Name (Legal Business Name): ROSALIZ RODRIGUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F5 AVE LOMAS VERDES
BAYAMON PR
00956-3101
US

IV. Provider business mailing address

F5 AVE LOMAS VERDES
BAYAMON PR
00956-3101
US

V. Phone/Fax

Practice location:
  • Phone: 787-612-5896
  • Fax:
Mailing address:
  • Phone: 787-612-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3657
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: