Provider Demographics
NPI:1538880786
Name:DE OLEO RODRIGUEZ, IRIS TEANY (PSYD)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:TEANY
Last Name:DE OLEO 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 1:1000 CARR 788 APT 129
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8805
Mailing Address - Country:US
Mailing Address - Phone:787-526-4288
Mailing Address - Fax:
Practice Address - Street 1:1000 CARR 788 APT 129
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-8805
Practice Address - Country:US
Practice Address - Phone:787-526-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical