Healthcare Provider Details

I. General information

NPI: 1093417156
Provider Name (Legal Business Name): PABLO JOAQUIN GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/20/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EUGENIO VELEZ SANTA BARBARA
GURABO PR
00778-0077
US

IV. Provider business mailing address

1 EUGENIO VELEZ SANTA BARBARA
GURABO PR
00778-9764
US

V. Phone/Fax

Practice location:
  • Phone: 787-586-4959
  • Fax:
Mailing address:
  • Phone: 787-586-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberDQ2022
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: