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General NPI Number Information
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NPI Number | 1811322969
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Entity Type | Organization
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Legal Business Name | CARLOS RODRIGUEZ, PH.D., P.C.
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 1301 W 17TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1915
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Country | US
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Telephone | 719-545-5211
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Fax | 719-545-1962
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Provider Business Mailing Address
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Address Line | PO BOX 3336
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City | PUEBLO
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State | CO
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Zip | 81005-0336
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Country | US
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Telephone | 719-545-5211
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Fax | 719-545-1962
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. CARLOS JOSE RODRIGUEZ
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Credential | PH.D
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Telephone | 719-545-5211
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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 | 1004
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License Number State | CO
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