Healthcare Provider Details

I. General information

NPI: 1588586960
Provider Name (Legal Business Name): MARIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. COCOS, PR-2 CARR 484, BO KM 0.1
QUEBRADILLAS PR
00678
US

IV. Provider business mailing address

PO BOX 9069
ARECIBO PR
00613-9069
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-4125
  • Fax:
Mailing address:
  • Phone: 787-356-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1115
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: