Provider Demographics
NPI:1104445303
Name:RODRIGUEZ ORTIZ, LUIS ADOLFO (TAC-III, TFC-III)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ADOLFO
Last Name:RODRIGUEZ ORTIZ
Suffix:
Gender:M
Credentials:TAC-III, TFC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0066
Mailing Address - Country:US
Mailing Address - Phone:787-558-0017
Mailing Address - Fax:
Practice Address - Street 1:D57 URB SAN MIGUEL
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2527
Practice Address - Country:US
Practice Address - Phone:787-558-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTAC-III-05-20-1226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)