Healthcare Provider Details

I. General information

NPI: 1487751707
Provider Name (Legal Business Name): GLORIA M. GONZALEZ - TEJERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ROOSEVELT 400 OFICINA 410 CLINICA LAS AMERICAS
HATO REY PR
00919
US

IV. Provider business mailing address

AVE. ROOSEVELT 400 OFICINA 410 CLINICA LAS AMERICAS
HATO REY PR
00919
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-6414
  • Fax: 787-763-7125
Mailing address:
  • Phone: 787-753-6414
  • Fax: 787-763-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6924
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number6924
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: