=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033487400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA D. RODRIGUEZ ROSA PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2011
-----------------------------------------------------
Last Update Date | 12/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BO. LOS LLANOS CARR. 14 KM. 27.8
-----------------------------------------------------
City | COAMO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-929-5511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 1 BOX 15781
-----------------------------------------------------
City | COAMO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00769-9756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-929-5511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3812
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------