Healthcare Provider Details

I. General information

NPI: 1821913294
Provider Name (Legal Business Name): MS. KARLA ANGELIE JUSTINIANO GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND. LA PROVIDENCIA 1327 AVE. SAN IGNACIO APT.1002
SAN JUAN PR
00921-3853
US

IV. Provider business mailing address

COND. LA PROVIDENCIA 1327 AVE. SAN IGNACIO APT.1002
SAN JUAN PR
00921-3853
US

V. Phone/Fax

Practice location:
  • Phone: 787-367-8345
  • Fax:
Mailing address:
  • Phone: 787-367-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8175
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: