Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3484 | PR |
Y | 103TC0700X | Clinical Psychologist | 3484 | PR |
NPI | 1003148057 |
---|---|
Provider Name | Dr. Benny Rodriguez |
First Address | Ponce, PR 00717 |
Second Address | Ponce, PR 00717-2054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 02/02/2010 |