Healthcare Provider Details

I. General information

NPI: 1700584455
Provider Name (Legal Business Name): VALERIE URBISTONDO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLLEGE PARK BUDAPEST 1776
SAN JUAN PR
00928
US

IV. Provider business mailing address

PO BOX 270454
SAN JUAN PR
00928-2454
US

V. Phone/Fax

Practice location:
  • Phone: 787-248-4903
  • Fax:
Mailing address:
  • Phone: 787-248-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007644
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: