Provider Demographics
NPI:1023877057
Name:RODRIGUEZ GUZMAN, RICARDO MARIO
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:MARIO
Last Name:RODRIGUEZ GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 CALLE JUAN BAIZ
Mailing Address - Street 2:APT 303 PARQUE DE LA VISTA I
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-236-0975
Mailing Address - Fax:
Practice Address - Street 1:COND. IBERIA 1
Practice Address - Street 2:554 CALLE PERSEO LC
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-236-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical