Healthcare Provider Details

I. General information

NPI: 1003729997
Provider Name (Legal Business Name): AIDYMAR RIVERA RODRIGUEZ PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 174
COMERIO PR
00782-0174
US

IV. Provider business mailing address

PO BOX 174
COMERIO PR
00782-0174
US

V. Phone/Fax

Practice location:
  • Phone: 939-430-8633
  • Fax:
Mailing address:
  • Phone: 939-430-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8858
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: