Healthcare Provider Details

I. General information

NPI: 1760601199
Provider Name (Legal Business Name): HIGINIO GONZALEZ PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

15 CALLE B URB. VILLA MILAGROS
YAUCO PR
00698-4503
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-6770
  • Fax: 787-832-6771
Mailing address:
  • Phone: 787-675-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2331
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: