Provider Demographics
NPI:1265763627
Name:BIDOT, SONIA RODRIGUEZ
Entity type:Individual
Prefix:MISS
First Name:SONIA
Middle Name:RODRIGUEZ
Last Name:BIDOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E5 CALLE 8
Mailing Address - Street 2:COLINAS VERDES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5304
Mailing Address - Country:US
Mailing Address - Phone:939-940-7721
Mailing Address - Fax:
Practice Address - Street 1:E5 CALLE 8
Practice Address - Street 2:COLINAS VERDES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5304
Practice Address - Country:US
Practice Address - Phone:939-940-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1519103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$Medicaid