=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558653634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABRO INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2011
-----------------------------------------------------
Last Update Date | 02/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | EXT. AVENIDA FAGOT URB. SANTA TERESITA 3260
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-585-4476
-----------------------------------------------------
Fax | 787-835-5394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 560-673
-----------------------------------------------------
City | GUAYAUILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-835-5394
-----------------------------------------------------
Fax | 787-835-5394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. ANASTACIO RODRIGUEZ
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 939-280-9752
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2573
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------