Healthcare Provider Details

I. General information

NPI: 1295640506
Provider Name (Legal Business Name): JOMAR RODRIGUEZ AGOSTO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. ANTONIO ROIG
HUMACAO PR
00791-3359
US

IV. Provider business mailing address

URB. EL RECREO A7 CALLE JUAN SANTOS QUINONES
HUMACAO PR
00791-3359
US

V. Phone/Fax

Practice location:
  • Phone: 787-590-9148
  • Fax:
Mailing address:
  • Phone: 787-590-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9241
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: