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General NPI Number Information
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NPI Number | 1356738355
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Entity Type | Individual
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Provider Name | ILIA I. RODRIGUEZ BAEZ PHD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | A-12 URB MANSIONES DE SAN GERMAN
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-923-0609
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Fax |
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Provider Business Mailing Address
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Address Line | A-12 URB MANSIONES DE SAN GERMAN
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5560
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License Number State | PR
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