Basic Information
Provider Information | |||||||||
NPI: | 1265460596 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RODRIGUEZ GUTIERREZ | ||||||||
FirstName: | ELAISA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | CHALETS DE ROYAL PALM | ||||||||
Address2: | APT. 902 | ||||||||
City: | BAYAMON | ||||||||
State: | PR | ||||||||
PostalCode: | 009563027 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7879952700 | ||||||||
FaxNumber: | 7879952706 | ||||||||
Practice Location | |||||||||
Address1: | HOSTOS AVE. | ||||||||
Address2: | #431 | ||||||||
City: | HATO REY | ||||||||
State: | PR | ||||||||
PostalCode: | 00918 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7879952700 | ||||||||
FaxNumber: | 7879952706 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2006 | ||||||||
LastUpdateDate: | 01/25/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 5440 | PR | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.