Healthcare Provider Details

I. General information

NPI: 1295641926
Provider Name (Legal Business Name): MAYRA A GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLAS DE SAN CRISTOBAL 2 CALLE ILAN ILAN CASA E-3
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

URB SAN CRISTOBAL 2 368 CALLE ILAN ILAN E-3
LAS PIEDRAS PR
00771
US

V. Phone/Fax

Practice location:
  • Phone: 787-378-4700
  • Fax:
Mailing address:
  • Phone: 787-378-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number487
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: