Healthcare Provider Details

I. General information

NPI: 1225993074
Provider Name (Legal Business Name): GLORIVETTE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JUAN SAN ANTONIO BO PUEBLO
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 1370
MOCA PR
00676-1370
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-0100
  • Fax:
Mailing address:
  • Phone: 787-464-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4205
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: