Provider Demographics
NPI:1386609352
Name:RODRIGUEZ FERNANDEZ, YANITZA (PHD)
Entity type:Individual
Prefix:DR
First Name:YANITZA
Middle Name:
Last Name:RODRIGUEZ FERNANDEZ
Suffix:
Gender:F
Credentials:PHD
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 1008
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1008
Mailing Address - Country:US
Mailing Address - Phone:787-884-0717
Mailing Address - Fax:787-884-0717
Practice Address - Street 1:B6 CALLE A S
Practice Address - Street 2:URB. FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5419
Practice Address - Country:US
Practice Address - Phone:787-884-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR553347OtherFHC & MCS
PR553347OtherFHC & MCS