Healthcare Provider Details

I. General information

NPI: 1427937937
Provider Name (Legal Business Name): RODRIGO G RODRIGUEZ ROSARIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 CALLE ACUARIO
CAROLINA PR
00979-1723
US

IV. Provider business mailing address

84 CALLE ACUARIO
CAROLINA PR
00979-1723
US

V. Phone/Fax

Practice location:
  • Phone: 787-228-5623
  • Fax:
Mailing address:
  • Phone: 787-228-5623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: