Provider Demographics
NPI:1194140947
Name:RODRIGUEZ, HECTOR R SR (005565)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:R
Last Name:RODRIGUEZ
Suffix:SR
Gender:M
Credentials:005565
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TURQUESA ST. 2100
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-469-7238
Mailing Address - Fax:
Practice Address - Street 1:TURQUESA STREET 2100
Practice Address - Street 2:SUITE 105
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-469-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical