Healthcare Provider Details

I. General information

NPI: 1013472257
Provider Name (Legal Business Name): DANIEL SERRANO GONZALEZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 08/28/2021
Certification Date: 08/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CARR 2 STE 215
BARCELONETA PR
00617-3240
US

IV. Provider business mailing address

42 CALLE BALBOA
ARECIBO PR
00612-6823
US

V. Phone/Fax

Practice location:
  • Phone: 787-908-2412
  • Fax:
Mailing address:
  • Phone: 787-908-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6913
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: