| Organization Name: | SERVICIOS PSICOLIGICOS RAIGAMBRE |
| NPI Number: | 1003922865 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARILYN RODRIGUEZ (ADMINISTRATOR/CLINICAL PSYCHOLOGIES) |
| Mailing Address: | Plaza Cupey Gardens Sector 3 San Juan |
| State: | PR US |
| Postal Code: | 00936 |
| Phone Number: | 7872920205 |
| Fax Number: | 7872920205 |
| NPI Enumeration Date: | 08/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |