Healthcare Provider Details

I. General information

NPI: 1609917897
Provider Name (Legal Business Name): MARILYN RODRIGUEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVE CUPEY GDNS PLAZA CUPEY GARDEN, SECTOR #3
SAN JUAN PR
00926-7341
US

IV. Provider business mailing address

HC 645 BOX 6387
TRUJILLO ALTO PR
00976-9746
US

V. Phone/Fax

Practice location:
  • Phone: 787-292-0205
  • Fax: 787-292-0205
Mailing address:
  • Phone: 787-292-0205
  • Fax: 787-292-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1693
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: