Healthcare Provider Details

I. General information

NPI: 1134567357
Provider Name (Legal Business Name): GLENDA LEE OQUENDO-RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MAGA MANSIONES DE LOS CEDROS
CAYEY PR
00736
US

IV. Provider business mailing address

22 HERACLIO MENDOZA
CAYEY PR
00736
US

V. Phone/Fax

Practice location:
  • Phone: 787-635-9987
  • Fax:
Mailing address:
  • Phone: 787-602-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number003793
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: