Healthcare Provider Details

I. General information

NPI: 1720536030
Provider Name (Legal Business Name): EDELMIRO ROJAS PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U5 CALLE 18 CASTELLANA GARDENS
CAROLINA PR
00983
US

IV. Provider business mailing address

U5 CALLE 18 CASTELLANA GARDENS
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-439-0600
  • Fax:
Mailing address:
  • Phone: 787-439-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5313
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: