Healthcare Provider Details

I. General information

NPI: 1871553354
Provider Name (Legal Business Name): LOURDES MARIE RODRIGUEZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 CALLE PARANA
SAN JUAN PR
00926-3145
US

IV. Provider business mailing address

PO BOX 70250 PMB 236
SAN JUAN PR
00936-8250
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-7063
  • Fax: 787-765-7063
Mailing address:
  • Phone: 787-765-7063
  • Fax: 787-765-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2360
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: