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General NPI Number Information
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NPI Number | 1578713921
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Entity Type | Individual
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Provider Name | JOSE ALEJANDRO LUCCA RODRIGUEZ PHD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 04/08/2017
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Provider Practice Location Address
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Address Line | URB. PERLA DEL SUR CALLE CARLOS CARTAGENA 4009 SUITE B
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-718-2589
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Fax |
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Provider Business Mailing Address
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Address Line | URB EXT ALTA VISTA CALLE 11 XX-1
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-718-2589
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3117
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License Number State | PR
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