Individual provider Active NPI

Zullyenivette Otero Rodriguez

  • Clinical Psychologist
  • Ponce, PR
National Provider Identifier
1114650371
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
8487 Issued in PR
Practice address
388 Zona Ind Reparada 2
Ponce, PR 00716-2347
Phone
(787) 840-2575
NPI assigned
Jul 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PR
Clinical Psychologist 103TC0700X 8487 PR Primary

Addresses

Primary practice location

388 Zona Ind Reparada 2
Ponce, PR 00716-2347

Mailing address

388 Zona Ind Reparada 2
Ponce, PR 00716-2347
Phone (787) 840-2575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260324004249 PR Practitioner - Clinical Psychologist 4385128669 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

13 Sect Flores Negron
Aguada, PR 00602-8400

Calle 25 de Julio 35 Prolongacion
Yauco, PR 00698

Calle 25 de Julio 35 Prolongacion
Yauco, PR 00698-3603

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8487PRMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Goldenminds LLC Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1114650371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 ZONA IND REPARADA 2",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007162347",
            "telephone_number": "787-840-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 ZONA IND REPARADA 2",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007162347",
            "telephone_number": "787-840-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTERO RODRIGUEZ",
        "first_name": "ZULLYENIVETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-06",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PR",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "8487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.