Healthcare Provider Details

I. General information

NPI: 1891294294
Provider Name (Legal Business Name): MARISELA DE LA CARIDAD RODRIGUEZ DR. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A24 CALLE C JARDINES DE CAROLINA
CAROLINA PR
00987-7102
US

IV. Provider business mailing address

A24 CALLE C JARDINES DE CAROLINA
CAROLINA PR
00987-7102
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-9160
  • Fax: 787-750-1139
Mailing address:
  • Phone: 787-768-9160
  • Fax: 787-750-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5991
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: