Provider Demographics
NPI:1285257832
Name:RODRIGUEZ, CARLOS SR (TRABAJADOR SOCIAL)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:RODRIGUEZ
Suffix:SR
Gender:M
Credentials:TRABAJADOR SOCIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ALTAGRACIA CALLE PAVO REAL
Mailing Address - Street 2:K-32
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-458-6103
Mailing Address - Fax:
Practice Address - Street 1:URB. ALTAGRACIA CALLE PAVO REAL
Practice Address - Street 2:K-32
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-458-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2314185OtherLICENCIA DE CONDUCIR
PR13457OtherTRABAJADOR SOCIAL