Provider Demographics
NPI:1871553354
Name:RODRIGUEZ, LOURDES MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70250
Mailing Address - Street 2:PMB 236
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8250
Mailing Address - Country:US
Mailing Address - Phone:787-765-7063
Mailing Address - Fax:787-765-7063
Practice Address - Street 1:1666 CALLE PARANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3145
Practice Address - Country:US
Practice Address - Phone:787-765-7063
Practice Address - Fax:787-765-7063
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR555145OtherFHC HEALTH SYSTEMS
PR2900OtherHUMANA INSURANCE
PR56792 ROOtherTRIPLE-S, INC.
PRA547OtherINTERNATIONAL MEDICAL CAR