Provider Demographics
NPI:1174763486
Name:RODRIGUEZ RODRIGUEZ, LIZA M (PSYD)
Entity type:Individual
Prefix:MISS
First Name:LIZA
Middle Name:M
Last Name:RODRIGUEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. RIVERVIEW
Mailing Address - Street 2:CALLE 17 T-6
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-0000
Mailing Address - Country:US
Mailing Address - Phone:939-645-6463
Mailing Address - Fax:787-846-7410
Practice Address - Street 1:302 CARR 168 # URB RIVERVIEW CALLE 17
Practice Address - Street 2:# T-6
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3864
Practice Address - Country:US
Practice Address - Phone:939-645-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4668103TC0700X
PR75771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4668Medicaid