Healthcare Provider Details

I. General information

NPI: 1558238915
Provider Name (Legal Business Name): IRMARELIS RODRIGUEZ CALDERON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE ACUARELA SUITE A-06
GUAYNABO PR
00969
US

IV. Provider business mailing address

URB. VALENCIA CALLE 11 AL-13
BAYAMON PR
00959-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-370-5454
  • Fax:
Mailing address:
  • Phone: 787-370-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6560
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: