Healthcare Provider Details

I. General information

NPI: 1396055364
Provider Name (Legal Business Name): ARIADNE RODRIGUEZ I PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 49 JARD DEL CARIBE YY46 NUMBER
PONCE PR
00728-2654
US

IV. Provider business mailing address

CALLE 49 JARDINES DEL CARIBE YY 46
PONCE PR
00728-2654
US

V. Phone/Fax

Practice location:
  • Phone: 787-644-9925
  • Fax:
Mailing address:
  • Phone: 787-644-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number359
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: