Provider Demographics
NPI:1386983641
Name:RODRIGUEZ, JOSE MANUEL (PSY D)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 CASON COVE DR
Mailing Address - Street 2:UNIT # 2112
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7429
Mailing Address - Country:US
Mailing Address - Phone:787-420-4084
Mailing Address - Fax:
Practice Address - Street 1:4641 CASON COVE DR
Practice Address - Street 2:UNIT # 2112
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7429
Practice Address - Country:US
Practice Address - Phone:787-420-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4829103TC0700X
FL9340346163W00000X
PR19641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No163W00000XNursing Service ProvidersRegistered Nurse