Healthcare Provider Details

I. General information

NPI: 1902964760
Provider Name (Legal Business Name): OPCIONES PSICOEDUCATIVAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DR BASORA #55 N MEDICA IV BLDG OFICE 201
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 6366
MAYAGUEZ PR
00682-6366
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-5583
  • Fax: 787-265-8145
Mailing address:
  • Phone: 787-265-5583
  • Fax: 787-265-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. VIRGILIO RODRIGUEZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 787-265-5583