Healthcare Provider Details

I. General information

NPI: 1609582212
Provider Name (Legal Business Name): LINEZKA ZOE DIAZ GONZALEZ LIC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CALLE JOSE C. BARBOSA
MOCA PR
00676
US

IV. Provider business mailing address

HC 2 BOX 12445
MOCA PR
00676-8263
US

V. Phone/Fax

Practice location:
  • Phone: 939-292-2422
  • Fax:
Mailing address:
  • Phone: 939-292-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7528
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: