MEDICARE: CAROLINE RODRIGUEZ PROFESSIONAL PSYCHOLOGIST, P.S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	2145	PR

General Provider Information

NPI Number	:	1922435999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINE RODRIGUEZ PROFESSIONAL PSYCHOLOGIST, P.S.C.

Provider Business Mailing Address
First Line	:	1106 CALLE REY JUAN CARLOS
Second Line	:	CONDOMINIO QUINTA REAL
City	:	TOA BAJA
State	:	PR
Zip	:	00949-2100
Country	:	US
Telephone Number	:	787-690-0311
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 DE DIEGO AVE
Second Line	:	SUITE 302
City	:	SANTURCE
State	:	PR
Zip	:	00909-1756
Country	:	US
Telephone Number	:	787-690-0311
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. CAROLINE RODRIGUEZ
Credential	:
Telephone Number	:	787-690-0311

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	10/04/2013

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