MEDICARE: GABRIEL DE ZAYAS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1073892261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL DE ZAYAS PHD

Provider Business Mailing Address
First Line	:	1302 CALLE LUCHETTI APT 4W
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1944
Country	:	US
Telephone Number	:	787-462-4229
Fax Number	:

Provider Business Practice Location Address
First Line	:	COND LAS LOMAS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2402
Country	:	US
Telephone Number	:	787-760-0222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	08/05/2011

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