Healthcare Provider Details

I. General information

NPI: 1245837327
Provider Name (Legal Business Name): CHRISTOPHER JOSE GOTAY SERRANO MRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 01/20/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LILAS ST. #1645 URB. FLAMBOYANES
PONCE PR
00716
US

IV. Provider business mailing address

LILAS ST. #1645 URB. FLAMBOYANES
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 939-245-8607
  • Fax:
Mailing address:
  • Phone: 939-245-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberTAC-III-05-20-2620
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number1671
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: