=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528554755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHANA M. ESTRADA RODRIGUEZ PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2018
-----------------------------------------------------
Last Update Date | 06/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE RVDO. DOMINGO MARRERO NAVARRO EDIFICIO #5, 3ER PISO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-688-6031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB VALLE ARRIBA HEIGHTS O16 CALLE EUCALIPTO
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-688-6031
-----------------------------------------------------
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 | 6209
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------