Healthcare Provider Details

I. General information

NPI: 1063351393
Provider Name (Legal Business Name): PAULIVETTE RODRIGUEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CALLE SOL
PONCE PR
00730-4881
US

IV. Provider business mailing address

51 CALLE SAN MARTIN
MAYAGUEZ PR
00680-2333
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-2900
  • Fax:
Mailing address:
  • Phone: 787-552-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8869
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: