1376881540 NPI number — DR. ABDIEL ELIAS DE LA PAZ RODRIGUEZ PSY.D

Table of content: DR. ABDIEL ELIAS DE LA PAZ RODRIGUEZ PSY.D (NPI 1376881540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376881540 NPI number — DR. ABDIEL ELIAS DE LA PAZ RODRIGUEZ PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA PAZ RODRIGUEZ
Provider First Name:
ABDIEL
Provider Middle Name:
ELIAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LA PAZ RODRIGUEZ
Provider Other First Name:
ABDIEL
Provider Other Middle Name:
ELIAS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376881540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. CHALETS DE LA FUENTE II,
Provider Second Line Business Mailing Address:
CALLE MONTE CASINO, CASA #8
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-463-8377
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 848 SAN ANTON
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL PLAZA 66 ST 5C
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-463-8377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  004582 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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