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General NPI Number Information
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NPI Number | 1396735395
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Entity Type | Individual
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Provider Name | JOSE DANIEL CAMACHO RODRIGUEZ PH. D.
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | COND THE EXECUTIVE #623 AVE PONCE DE LEON APT 1101-B
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone | 787-934-0752
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Fax | 787-728-7398
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Provider Business Mailing Address
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Address Line | 1 CALLE HNOS RODRIGUEZ EMA APT 1105
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City | CAROLINA
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State | PR
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Zip | 00979-5809
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Country | US
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Telephone | 787-934-0752
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Fax | 787-728-7398
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1272
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 1272
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1272
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License Number State | PR
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