Individual
EZEQUIEL MEDINA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
COND SANTA RITA # 1000, SAN JUAN, PR 00925-2857
(787) 633-3335
Mailing address
PO BOX 141446, ARECIBO, PR 00614-1446
(787) 633-3335
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TS0200X
School Psychologist
Primary
3270
PR
Other
Enumeration date
02/07/2009
Last updated
02/07/2009
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