Healthcare Provider Details

I. General information

NPI: 1306740972
Provider Name (Legal Business Name): COPAN COMMUNITY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

EDIFICIO GUBERNAMENTAL JOSE ARCHILLA CABRERA CARR 825 KM 1 BO ACHIOTE
NARANJITO PR
00719-9998
US

IV. Provider business mailing address

117 CALLE REINA
DORADO PR
00646-9401
US

V. Phone/Fax

Practice location:
  • Phone: 787-699-8689
  • Fax:
Mailing address:
  • Phone: 787-438-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANNETTE RODRIGUEZ RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-438-9306