Healthcare Provider Details

I. General information

NPI: 1538492152
Provider Name (Legal Business Name): ISMAEL GONZALEZ-MARTINEZ PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 AVE CONDADO SUITE 603
SAN JUAN PR
00907-3843
US

IV. Provider business mailing address

PO BOX 8362
SAN JUAN PR
00910-0362
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-5353
  • Fax:
Mailing address:
  • Phone: 787-753-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001736
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001736
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001736
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number003109
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number003109
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number003109
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number003109
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: