Healthcare Provider Details

I. General information

NPI: 1316853963
Provider Name (Legal Business Name): GUSTAVO LUIS AYMAT RODRIGUEZ PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1561
MOCA PR
00676-1561
US

IV. Provider business mailing address

PO BOX 253
CABO ROJO PR
00623-0253
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-0100
  • Fax:
Mailing address:
  • Phone: 787-677-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7115
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: