Healthcare Provider Details

I. General information

NPI: 1851520290
Provider Name (Legal Business Name): GUILLERMO E SANCHEZ RODRIGUEZ M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F7 JARDINES DE RINCON
RINCON PR
00677
US

IV. Provider business mailing address

PO BOX 6523
MAYAGUEZ PR
00681-6523
US

V. Phone/Fax

Practice location:
  • Phone: 787-517-4730
  • Fax: 787-609-8375
Mailing address:
  • Phone: 787-517-4730
  • Fax: 787-609-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3451
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3451
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: