Healthcare Provider Details

I. General information

NPI: 1710728225
Provider Name (Legal Business Name): OLGA IRIS GONZALEZ VIRUET PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 68.2 INTERIOR EDIFICIO F. SOTO SEGUNDO PISO SUITE 201
ARECIBO PR
00612-4521
US

IV. Provider business mailing address

235 LA REPRESA
ARECIBO PR
00612-6913
US

V. Phone/Fax

Practice location:
  • Phone: 787-454-7955
  • Fax:
Mailing address:
  • Phone: 787-454-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7954
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: