Healthcare Provider Details

I. General information

NPI: 1821906264
Provider Name (Legal Business Name): EDWIN RAFAEL GONZALEZ MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESQUINA 6, 1211 EXTENSION, CALLE 3
SAN JUAN PR
00926
US

IV. Provider business mailing address

319 VIA ESCORIAL URB VILLAS REALES
GUAYNABO PR
00969-5344
US

V. Phone/Fax

Practice location:
  • Phone: 787-759-2121
  • Fax:
Mailing address:
  • Phone: 787-399-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number9044
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: