Provider Demographics
NPI:1871606848
Name:RODRIGUEZ, JAVIER (MSP)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 COND VISTA REAL II
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-7855
Mailing Address - Country:US
Mailing Address - Phone:787-473-7332
Mailing Address - Fax:
Practice Address - Street 1:20 URB CATALANA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2774
Practice Address - Country:US
Practice Address - Phone:787-473-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2437103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist