Provider Demographics
NPI:1194424192
Name:RODRIGUEZ TORRES, SARA IDELISE (MCP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:IDELISE
Last Name:RODRIGUEZ TORRES
Suffix:
Gender:F
Credentials:MCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 7185
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9584
Mailing Address - Country:US
Mailing Address - Phone:787-949-7082
Mailing Address - Fax:
Practice Address - Street 1:BO. SANTA ROSA 3 SECTOR LOS RODRIGUEZ CARR. 833 KM 9.5
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-949-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005576103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4700004OtherID