Provider Demographics
NPI:1407320484
Name:RODRIGUEZ-LAZU, MARITZA (PSYD, CGG)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:RODRIGUEZ-LAZU
Suffix:
Gender:F
Credentials:PSYD, CGG
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 262294
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2655
Mailing Address - Country:US
Mailing Address - Phone:939-270-0902
Mailing Address - Fax:
Practice Address - Street 1:CHIRINO OFFICE PLAZA CARR. 8838 #1739
Practice Address - Street 2:SUITE 204L BO. MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2745
Practice Address - Country:US
Practice Address - Phone:939-270-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5988103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling