Healthcare Provider Details

I. General information

NPI: 1306654157
Provider Name (Legal Business Name): NIDZALIZ GONZALEZ RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO EL CENTRO 1 AVE. MUNOZ RIVERA #500 OFICINA 242
SAN JUAN PR
00918
US

IV. Provider business mailing address

PR6 VIA 19
CAROLINA PR
00983-4705
US

V. Phone/Fax

Practice location:
  • Phone: 787-587-7590
  • Fax:
Mailing address:
  • Phone: 787-587-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8156
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: